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.