Saturday, September 22, 2012

On Taking Nutritional Supplements for Knee Pain

A question came up recently in the comments section that went like this: I know you admire Doug Kelsey. What do you think of his recommendation that people with stiff joints take SAM-e and omega three supplements?

First, I do have tremendous respect for Kelsey. More than anyone, he helped put me on the right track to healing my bad knees -- and we don’t know each other and have never so much as exchanged a single word about knee pain or anything else for that matter.

However, I diverge from his thinking somewhat when it comes to supplements. To be fair, I haven’t done much research into supplements, with one notable exception: glucosamine. So the following is based on my own limited personal experience with supplements and my own reflections on how I healed. Take it for what it’s worth.

Here are four reasons I’m not a big believer in them:

(1) Glucosamine, the all-star of the bunch, is most likely a dud.

Sentiment in the medical community is starting to swing around on glucosamine, which in the early 2000s looked like it might be a wonder supplement to rebuild worn-out cartilage. Larger, better-run, more independent studies show that it’s probably just a placebo.

The fatal chink in the glucosamine story (as I observe in Saving My Knees) is that orally swallowed glucosamine is largely banged apart by your liver, leaving only inconsequential amounts to circulate intact through your bloodstream to your knee joints. This has been shown by at least two medical studies I’m aware of.

(2) I suspect the benefits of supplements are marginal, if anything.

I took several different types of “stop knee pain now!” and “rebuild your bad knees!” pills during my battle with chronic knee pain. I also ate a lot of garlic (touted as a natural anti-inflammatory). And of course I popped glucosamine for months, as I mention in Saving My Knees.

I experienced no discernible benefits from any of the above.

However, sticking to a good, sensible diet strikes me as a good idea. I do recall a few occasions when, after eating too much fatty, greasy, high-calorie food, I had more knee discomfort than normal.

(3) If you get the physical part right, I think the chemistry will follow.

Which means: A lot of these dietary supplements aim to reduce pain and inflammation. Certainly there is a biochemical basis for pain and inflammation. And you can choose to fight those problems on that level.

But in most cases, I suspect, the physical stuff (how you move, how often you move, what kind of load is on your joints when you move) greatly influences all of that biochemistry. In other words: If you want less inflammation in your knee, make sure you’re committed to a program of the right kind of motion, in the right amount. And the biochemical part will fix itself. (Note: this doesn’t apply, unfortunately, the same way to knee issues stemming from a systemic auto-immune disorder.)

(4) Focusing on healing through motion is simpler and cheaper.

Of course it’s not exactly simple -- you still have to figure out what activities, in what amounts, make your knees happy, and help restore them to good health.

But supplements, at least in my opinion, come with a difficult set of questions. Which supplements? How much of each? Does the brand matter? Do they interact with anything you’re already taking? Do they have side effects? And so on.

And the biggest question: How can you tell if they’re working and worth all the money you’re shelling out for them? Even if you’re certain that a particular one reduces pain and inflammation, is it really helping improve the strength of your knees? Because, ultimately, your goal isn’t just to be pain free, but to have stronger knees so you can hike up a mountain or bike to the shore without having problems.

Those are my thoughts on supplements. During my recovery, I did take extra protein, thinking my diet might not be providing enough, and my body needed more protein than normal anyway to assist in healing. But my (limited) experience with supplements was generally disappointing.

Anyone else want to share? Which ones worked or didn’t for you? Please chime in below!

Update: Readers, since posting this, I came across this New York Times piece about knee pain that suggests that SAM-e probably doesn't work:
Well-designed clinical studies have shown no significant relief of arthritic knee pain from supplements of glucosamine and chondroitin sulfate, taken alone or in combination, though Dr. Felson said that if people feel better taking them, he does not discourage the practice. Nor is there good evidence of benefit from methylsulfonylmethane, SAM-e or acupuncture.


  1. I tried Glucosamine with the full belief that it would help, but I did not sense that it helped at all. Could be that I just didn't give it enough time to "kick in" but I gave up. A dancer friend of mine swears by it! But I tried and tried and tried but it didn't seem to lessen my knee sensitivity to flare ups and irritation. I didn't even benefit from any placebo effect -- even though I truly believed that it would help.

    All along I kept blaming myself that it wasn't helping because I wasn't doing it right. But.... After reading Saving My Knees then that was the first time someone suggested the reason it wasn't working for me was because it doesn't work. I had this feeling of relief, "oh thank goodness I don't have to make another go at glucosamine!"

  2. Hi amazing to read your blog. Im 23 years old with severe runners knee going for almost 2 years. Well I did the scope since mine started after an injury what was found was just "small grade cartialage injury" the OS, a very famous one said "This is alright, this is nothing" Tried PT for a long time, always thinking "Man this exercises are to hard for me, I ain't getting better at all"

    Went back to my OS and met with his PT working at the clinic. That PT told me yep it's too hard start slow with biking, and just a few quad sets. Kind of like what you are talking about here.

    I can't belive regular PT's arent taught this in school, about cartillage damage and how to rehab it. Leg extensions and squats are not helping me...

    The strange, (and horrible) thing about my knee is that I have no idea whats aggrivating it and whats making it better. Somedays maybe once a month it feels great and I can even walk normally and Im so happy, the next day not so happy. Anyway now Im going to try.

    10 light quad sets + 5 min bicycle zero resistance daily. Il give it a few weeks. If I improve i will ramp up to 10 min bike.

  3. Have posted a few times here under a 'handle' but for a lot of reasons am just going to post anonymously today. Read Richards book a few months ago and my knee(s) have improved tremendously in that time since, although it is possible I may have a loose body left over from my surgery, which is another story. Anyway, thanks Richard for the great insights, many were very apropos for MY knees.

    I too have tried all the usual suspects with respect to supplements and I think Richard is right, they're mostly duds... although I don't think that we can discount the possible healing potential of placebo, however one gets to that place where the mind becomes empowered and participates in the healing process- Without attempting to get into the details of those potentials or limitations.

    All of that heavy windedness aside, I have been taking a supplement for a few months now called UC 11, which is short for "Undenatured Collagen Type 11 and it seems to be helping along with modifications in my PT regime. There several studies that you can find readily on the web that demonstrate it's efficacy and some are quite detailed and well done and deserve scrutiny.

    Good luck all with healing your knees

  4. Oh Richard btw don't now if I missed something. But an MRI with a "pfps" patient does show irritation in the kneejoint behind the patella. Why is that if it's the bone that's irritated?

    1. First, whatever the MRI shows, I doubt it's actually "irritation." Did you see that in the report? Maybe it's irregularities in the cartilage? That seems more likely.

      So irregularities/thinning/defects would suggest that the cartilage has lost some of its capability to act effectively to cushion shock. At the same time though, this tissue has no nerves -- so it can't send out pain signals. However the bone ending (on the other side of the cartilage) is nerve rich. So when the cartilage is flawed, I understand that the bone can give off pain signals.

  5. I was diagnosed with degenerative joint disease at the age of ten. It didn't hurt much, but my joints made a nasty clicking sound - mostly wrists, toes, ankles, shoulder or elbow. I put up with this while it got worse. By my late twenties It sounded like someone playing the castanets when I walked.

    Then I saw a book touting Glucosamine Sulphate and Chondroitin Sulphate 1500mg and 500mg respectively. It emphasized taking the two together at that exact dose. I tried it. It worked.

    After three weeks there was no more noise. If that is placebo effect it was spectacular.

    Every few years the clicking noise comes back in a joint so I take it again, and again it goes. That's a pretty good result after 27 years of misery. I don't care if science says it can't work. The bumblebee couldn't fly for years according to science.

    I have recommended GS and CS a lot, though I don't recall anyone with bad knees. Perhaps the knee is an especially difficult joint to treat, having half the weight of the body to support on a tiny surface area.

    There was only one non-responder, to my recollection, and he had no cartilage left in his joint.

  6. I tried glucosamine 2 years ago and here's a different aspect to it. I didn't try it long enough to figure out if it works or is a dud. within 48 hours of taking it the first time, I had the WORST intestinal gas and discomfort I've ever had so I stopped. A few months later, i gave it another shot and the same thing happened.