Joint Health Supplements Review (Glucosamine,
Chondroitin, MSM, Boswellia, Collagen and Turmeric)
Medically reviewed and
edited by Tod Cooperman, M.D. 
Last Updated
: 09/19/2021 | Initially Posted:
08/14/2021
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Table of Contents
Summary
·
Do supplements for joint pain and joint health work? Several dietary
supplement ingredients may help reduce joint pain (particularly of the knee or
hands, but not the back or hip) due to osteoarthritis (worn joints), although
the evidence is not overwhelming (see What It Does). As noted below, ConsumerLab.com
tested the quality of products containing one or more of these ingredients.
·
Which joint health supplements are best? Several products
failed to provide the amounts of ingredients listed on their labels — with
amounts ranging from just 1.8% to 55.2% (see What CL Found). Products that passed tests for
quality are noted as "Approved" in the Results Table below. Approved products
that also provided high-quality ingredients at lowest cost — indicating
superior value, were selected as CL's Top Picks).
·
How much to take?
·
Glucosamine (including NAG) and chondroitin: These may be used
separately, but most studies have looked at these in combination. Modest pain
relief may take several months. Look for products providing a total daily dose
of 1,200 mg of glucosamine (sulfate or HCl) with or without 800 mg to 1,500 mg of
chondroitin sulfate. See What it Does — Glucosamine and Chondroitin and ConsumerTips™: Glucosamine and Chondroitin.
·
MSM: Although in many products, the evidence is very limited
for MSM. In animals, it is used to treat muscle soreness. An optimal dose has
not been established, but dosage typically ranges from 500 mg to 3,000 mg.
See What It Does — MSM and ConsumerTips™: MSM.
·
Boswellia: The resin of this plant contains an anti-inflammatory
compound, AKBA, so its effects should be felt within a few days or weeks. Note
that if only Boswellia resin is listed, it is likely less
potent than Boswellia extract (i.e., an extract from the
resin), as only about 1% of the resin is AKBA, while 6% to 40% of the extract
is AKBA. (We show the amount of AKBA found in each product in the Results table.) A typical daily dose of Boswellia
extract is 100 mg to 250 mg. Taking Boswellia extract along with fatty foods
may enhance absorption. See What It Does — Boswellia and ConsumerTips™: Boswellia.
·
Turmeric: Curcuminoids and other compounds in turmeric provide an
anti-inflammatory effect that may provide modest benefit in rheumatoid
arthritis and osteoarthritis, although no better than anti-inflammatory
medicines. The typical daily dose ranges from 500 mg to 2,000 mg of
curcuminoids (most of which is curcumin) from turmeric extracts,
which may be as much as 95% curcuminoids. Products that have shown benefit are
typically formulated for enhanced absorption, as curcuminoids are otherwise not
well absorbed unless taken with meal containing fats. (For tests of additional
turmeric products and more details about their use, see our separate Turmeric and Curcumin Supplements
Review.)
·
Collagen: Collagen may modestly improve join pain and flexibility in
osteoarthritis, although effects can require two to six months of daily use.
The type of collagen most studied for this use is undenatured collagen (such as
UC-II and Vital 3), which is different from the hydrolyzed collagen typically
used to improve skin appearance. (For tests of additional collagen products and
more details about their use, see our separate Collagen Supplements Review).
·
Combinations: Although combinations are convenient,
their formulas (other than glucosamine and chondroitin) typically have not been
clinically tested. Before trying a combination, try products with specific,
single ingredients and see which, if any, help. This approach can also be less
expensive, as combinations are sometimes more expensive than buying each of the
ingredients separately.
·
Joint health supplements safety, side effects and drug
interactions: Most of these ingredients can cause some gastrointestinal
upset (such as nausea) and, although generally safe, some can interact with
drugs (such as those for blood thinning), trigger allergies, or cause other
side-effects. See Concerns and Cautions.
For other types of supplements that may be helpful in treating joint pain, see
ConsumerLab.com's reviews of SAMe, Ashwagandha, Cinnamon and Ginger.
(See Separate
Review of Joint Health Supplements for Pets >>)
What It Is:
Glucosamine and Chondroitin:
Glucosamine and chondroitin sulfate occur naturally in the body. The
glucosamine used in supplements is typically derived from the shells of shrimp
or crabs although a corn source is also available (look for products
identifying as non-shellfish). Glucosamine is available in a variety of
chemical forms, such as glucosamine hydrochloride and glucosamine sulfate.
These differ in terms of the amount of actual glucosamine available for use in
the body from an equal weight of each form (See ConsumerTips™: Glucosamine and Chondroitin for
more information). Chondroitin sulfate is generally derived from pig or cow
cartilage, but even shark and chicken cartilage has been used.
"Vegan" chondroitin, such as the product Mythochondro (which
is derived from fermented bacteria) and chondroitin-like mucopolysaccharides
from algae are also available.
MSM:
MSM (methylsulfonylmethane) occurs naturally in the body but MSM in supplements
is produced synthetically.
Boswellia:
The gum resin of the Indian frankincense tree (Boswellia serrata)
contains compounds (boswellic acids) thought to have anti-inflammatory
properties. Most supplements contain an extract of this resin, often
standardized to contain specific amounts of one or more of these boswellic
acids, such as AKBA and KBA.
Turmeric:
Curcuminoids and other compounds in turmeric provide an anti-inflammatory
effect. Turmeric extracts may be as much as 95% curcuminoids.
Products that have shown benefit are typically formulated for enhanced
absorption, as curcuminoids are otherwise not well absorbed unless taken with
meal containing fats.
Collagen:
Collagen is the most abundant protein in the body. It is a rich source of amino
acids -- especially glycine, proline, and hydroxyproline, which are used by the
body to build new collagen. Collagen supplements are typically derived from
animal sources such as cows, pigs, chicken, or fish, and occasionally, from
other sources, such as eggshell membranes. There are many types of collagen,
but supplements for joint health typically contain type II collagen, which is
found most abundantly in cartilage.
What It Does:
Glucosamine and Chondroitin:
Glucosamine and chondroitin sulfate supplements are used in hopes of slowing
the progression of osteoarthritis (the deterioration of cartilage between joint
bones) and reducing the associated pain. Glucosamine is thought to promote the
formation and repair of cartilage. Chondroitin is believed to promote water
retention and elasticity in cartilage and inhibit enzymes that break down
cartilage.
Many studies have been
conducted with glucosamine and chondroitin (some are described below) and the
results have been mixed. In short, they may modestly reduce knee pain
if you have moderate to severe knee pain, although benefits may not occur for
several months. In addition, if you have mild to moderate osteoarthritis,
particularly of the knee, these agents may, over a period of years, slightly
reduce the extent of further loss of cartilage volume. These agents
generally do not appear to improve functioning of the knee, nor do they
help with back pain or hip pain caused by osteoarthritis. However,
chondroitin sulfate has shown some benefit over a 6-month period in
people with hand osteoarthritis.
Due to concerns about the
quality of evidence (i.e. most of the studies showing a benefit have been
company-funded, while studies with the least risk of bias have not found a
benefit) the American College of Rheumatology/Arthritis Foundation has advised
against supplementation with glucosamine for knee, hip or hand osteoarthritis.
It also advised against chondroitin supplementation for knee and hip
osteoarthritis, but noted that one trial suggests a benefit with chondroitin
sulfate for hand osteoarthritis (Kolasinki, Arthritis Rheumatol 2020).
Interestingly,
one possible way in which glucosamine and chondroitin may work is by changing
the bacterial population of the gut toward bacteria known to produce
short-chain fatty acids, such as butyrate -- which can act as an
anti-inflammatory agent. This was shown in a small, placebo-controlled study in
which 10 subjects took three capsules (Cosamin DS, each containing 500
mg of glucosamine hydrochloride and 400 mg of chondroitin sulfate) daily for
two weeks (Navarro, Microorg 2019).
Two major studies of the
combination of glucosamine and chondroitin for knee osteoarthritis have
been conducted, with somewhat different results -- although this may be due to
differences in the form of glucosamine used and in the study populations. A
study sponsored by the National Institutes of Health (NIH), called the
Glucosamine/Chondroitin Arthritis Intervention Trial (or GAIT study), showed that the combination of
glucosamine hydrochloride (1,500 mg per day) and chondroitin sulfate (1,200 mg
per day) did not reduce narrowing of the joint space of the knee and only
reduced knee pain among people starting with moderate to severe knee pain, not
those with mild pain.
A later study in
Australia (the Long-term Evaluation of Glucosamine Sulfate or LEGS study) used glucosamine sulfate (1,500
mg per day) instead of glucosamine hydrochloride, as well as chondroitin
sulfate (800 mg per day). That study focused primarily on people with early
disease and mild pain. Although all patient groups receiving glucosamine and/or
chondroitin reported a reduction in pain, the reduction was not significantly
greater than among those receiving placebo. However, the amount of joint space
narrowing which occurred during the study (an indicator of disease progression)
among those taking the combination of glucosamine and chondroitin was only half
the amount of narrowing which occurred among those who received placebo, and
taking either glucosamine or chondroitin alone had no significant effect on
narrowing. It would seem that the combination of these two ingredients may be
important, and glucosamine sulfate may be more useful than glucosamine
hydrochloride in slowing the progression of knee osteoarthritis.
A
6-month study in Europe found that 800 mg of pharmaceutical-grade chondroitin
sulfate (95% pure, Chondrosulf, IBSA, Switzerland — sold as a medicine in
Europe but not yet sold in the U.S.) was similar to 200 mg of celecoxib
(Celebrex) in reducing pain and improving function relative to placebo in
people with mild to moderate knee osteoarthritis. It should be noted, though,
that improvement took longer with chondroitin (6 months vs. 3 months for
celecoxib), and the improvement for both treatments was only somewhat greater
than with placebo, i.e., on a pain scale of 0-100, pain fell by 42.6 points
with chondroitin, 39.6 points with celecoxib, and 33.3 points with placebo. All
treatments (taken with a glass of water every evening) demonstrated excellent
safety profiles. Due to the potential for side-effects with celecoxib (a
non-steroidal anti-inflammatory), the researchers suggested that chondroitin
sulfate should be considered as a first-line treatment for knee osteoarthritis
(Reginster, BMJ Ann Rheum Dis 2017).
A small study in Italy among overweight men and women (average
age 62) with mild to moderate knee osteoarthritis (or impaired knee mobility
and pain) found that 600 mg of non-animal derived chondroitin sulfate
(Mythocondro, by Gnosis Inc., which funded the study) taken once daily for three
months modestly improved knee function and mobility, and reduced knee pain,
compared to placebo. Certain measures of inflammation in the body (CRP and
erythrocyte sedimentation rate (ESR)) also decreased among those taking
chondroitin compared to placebo. Mythocondro is produced through fermentation
of sugar by a specific strain of E. coli, resulting in the
formation of chondroitin, to which sulfate is chemically added. The final
product is purified and endotoxins are monitored to "guarantee the safety of
the final product" (Rondenelli, Nutrients 2019).
It is sold in the U.S. as "vegetarian chondroitin sulfate sodium"
in Health Logics Mytho Condro. ConsumerLab has not yet tested any
products containing this form of chondroitin.
A 6-year study among
people who reported using glucosamine and chondroitin (no specific product) and
had knee osteoarthritis without total loss of cartilage found no effect on pain
reduction but a slight (1%) reduction in cartilage volume loss, particularly in
the lateral compartment of the knee (Raynauld, Arthritis Care Res, 2016).
A
short-term (6-month) study in Spain of 164 patients with moderate to severe
pain from knee osteoarthritis, taking 1,500 mg of glucosamine sulfate with
1,200 mg of chondroitin sulfate daily failed to demonstrate superiority over
placebo in reducing pain and improving joint function limitation (Herrero-Beaumont, Osteoarth Cartlg
2016 OARSI abstract).
A 6-month study of
glucosamine hydrochloride (1,500 mg daily from Regenasure as a beverage) in
patients with mild to moderate knee pain found that it did not decrease pain,
reduce worsening of cartilage damage, or improve bone marrow lesions in the
knee (thought to be a source of pain in those with osteoarthritis) compared to
placebo (Kwoh, Arth & Rheum 2014). Glucosamine also
did not decrease urinary levels of peptides considered predictors of cartilage
destruction. The report notes that some longer-term studies using glucosamine
sulfate, rather than glucosamine hydrochloride, have shown benefit in knee
osteoarthritis.
A
well-controlled study of glucosamine sulfate (1,500 mg per day) versus placebo
for lower back pain caused by osteoarthritis showed that both
glucosamine and placebo improved symptoms reported by patients. However, there
was no significant difference in the level of improvement between the groups,
suggesting that glucosamine is not truly effective for lower back pain (Wilkens, JAMA 2010).
A 2007
review of several past, large-scale studies of chondroitin alone concluded that
it did not provide a benefit in osteoarthritis of the knee or hip (Reichenbach, Ann Intern Med 2007). However, a
2015 review of past studies concluded that chondroitin "may improve pain
slightly in the short-term (less than 6 months)" and in 6 out of 100
people it may improve pain by 20%. In addition, chondroitin "slightly
slows down narrowing of the joint space" and people taking it actually
reported fewer adverse effects than those taking placebo (Singh, Cochrane Library 2015).
A six-month study of
chondroitin sulfate (800 mg once daily) versus placebo in patients with hand
osteoarthritis showed a significantly greater decrease in hand pain
and improvement in hand function among those taking chondroitin sulfate (Gabay, Arth & Rheum 2011).
The duration of morning stiffness was also slightly reduced. These benefits
were not noticeable until after 3 months of treatment. There was no significant
difference in grip strength or the amount of analgesic used by patients. The
chondroitin tested in the study was a tablet containing highly purified (95%
pure) chondroitin of fish origin and is marketed as Chondrosulf (IBSA,
Switzerland) in Europe where it is approved as a "Symptomatic Slow Acting
Drug for Osteoarthritis" (IBSA website — accessed 9/21/2011). Similarly,
patients with hand and knee osteoarthritis who were given 1,500 mg of
glucosamine sulfate daily to help treat osteoarthritis of their knees showed,
after 3 months, a significantly greater decrease in hand pain and improvement
in hand function as compared to patients not given glucosamine. Both groups
were prescribed hand exercises and anti-inflammatory medication — although the
patients receiving glucosamine chose to use lower amounts of the
anti-inflammatories. Weaknesses of the study were that it was conducted
retrospectively, lacked a placebo, and both doctors and patients were aware of
the treatment given (Tenti, Aging Clin Exp Res 2019).
The glucosamine used was a patented crystalline glucosamine sulfate made by
Rottapharm which is sold in the U.S. as Dona, which ConsumerLab
tested in 2016 and was Approved for quality.
Interestingly,
a study of Washington state residents aged 50 to 76 years found that use of
glucosamine and use of chondroitin were each associated with a statistically
significant decrease in mortality (a 17% lower risk of death
during a 5-year study period), while there was no such association for 13
different vitamins and minerals, fish oil, fiber, or several herbal
supplements. The authors proposed that the apparent benefit with glucosamine
and chondroitin may relate to their anti-inflammatory properties (Pocobelli, Am J Clin Nutr 2010). Further
analysis of the data revealed that the benefit may primarily rest with
glucosamine (which is in most chondroitin supplements), as there was an even
greater reduction (22%) in risk of death associated with glucosamine without
chondroitin. Glucosamine was also associated with a particularly large (41%)
reduction in risk of death from respiratory diseases such as lung cancer (Bell, Eur J Epidemiol 2012). Similarly, a
study of nearly half a million adults in the UK found that self-reported
glucosamine use was associated with a 15% lower risk of cardiovascular
disease, a 22% lower risk of death, an 18% lower risk
of coronary heart disease (with an even greater effect in current
smokers -- a 37% lower risk), and a 9% lower risk of stroke over a period of
about 7 years after adjusting for potentially confounding variables. Although
information about the dose and type of glucosamine was not collected,
glucosamine is a prescription medication in the UK (and Europe) and most
products are glucosamine sulfate (Ma, BMJ 2019). Additional
analysis of the same data found regular use of glucosamine was also associated
with a 17% lower risk of type 2 diabetes, even after adjusting for
common risk factors (Ma, Diabetes Care 2020).
In veterinary medicine,
glucosamine and chondroitin, often in combination, are commonly used in the
treatment of degenerative joint disease typically in older dogs and cats as
well as in horses. (See separate review of Joint Health Supplements for Pets).
NAG:
A form of glucosamine called N-acetyl-glucosamine, or NAG, may be
beneficial for inflammatory bowel diseases (IBD) such as Crohn's
disease and ulcerative colitis — although the
supporting evidence is far from conclusive and based on studies that lacked
placebo controls. NAG is naturally produced in the body and helps to maintain
and repair the mucus lining of the gastrointestinal tract. In Crohn's disease
and ulcerative colitis, the body's ability to produce NAG may be reduced (Goodman, Gut 1997). A study in children with
severe treatment-resistant Crohn's disease or ulcerative colitis found 8 of 12
children who received NAG powder (3 - 6 grams taken with water in three divided
doses daily) had clinical improvement; 4 had no improvement and required
surgery (Salvatore, Aliment Pharmacol Ther
2000). In another small study, adults with IBD who were given 6
grams of NAG powder (Villicote, Wellesley Therapeutics Inc.) daily -- as
three divided doses of 2 grams each, added to water — experienced improvements
in symptoms: 58.8% reported improvement in abdominal pain (average symptom
score decreased by 49%), 64.7% reported improvement in diarrhea symptoms
(average symptom score decreased by 47%) and 41.2% reported improvement in
nausea symptoms (average symptom score decreased 55%) (Zhu, Natr Med J 2015).
Health Canada allows the claim, "Helps promote a healthy intestinal lining
in people with symptoms associated with inflammatory bowel disease," for a
product providing a daily dose of 3,000 mg of N-acetyl-glucosamine and 600 mg
vitamin C (C-NAG, Vitex). There are no published clinical studies of the
effects of NAG on irritable bowel syndrome (IBS), but one is
underway (NCT02504060).
NAG may also be
beneficial for joints, according to a placebo-controlled study that found that
a daily dose of 500 mg N-acetyl-glucosamine slowed the breakdown and increased
the production of type II collagen in healthy adults (average age 48) without arthritis
(Tomonaga, Exp Ther Med 2016). In older adults
in Japan with knee pain and stiffness, a combination N-acetyl glucosamine (100
mg) and chondroitin sulfate (180 mg) taken daily for five months modestly
improved function during household activities, but did not improve leisure time
physical activity or reduce pain, compared to placebo (Tsuji, Aging Clin Exp Res 2016).
MSM:
MSM is used primarily for treating pain associated with osteoarthritis and has
been proposed for treating other conditions including rheumatoid arthritis,
inflammation of the bladder wall (interstitial cystitis), snoring, muscle
spasm, and cancer. All of these uses for MSM, including those for arthritis,
are based on limited research, so its effectiveness hasn't been well
established. A small placebo-controlled study of MSM in
women and men competing in a half-marathon found that those taking MSM (3,000
mg per day for 21 days prior to the race and 2 days afterward) experienced less
muscle and joint pain after the race, but the reductions were not deemed
statistically significant and MSM did not reduce biological markers of
oxidative stress and muscle damage (Withee, J Int Soc Sports Nutr 2017).
Many additional claims are found on MSM products, including skin-softening and
nail-strengthening effects, but none of these are well supported by research.
The mechanism by which MSM may work isn't well understood, although it is known
to contribute sulfur to the body, which can then be used to synthesize certain
amino acids (building blocks for proteins), and it can act as an antioxidant.
As a veterinary medicine, MSM is used to treat muscle and tendon soreness and
inflammation in horses -- see separate review of Joint Health Supplements for Pets.
Boswellia:
One particular boswellic acid known as AKBA (3-O-acetyl-11-keto-beta-boswellic
acid) appears to be the most potent anti-inflammatory component. AKBA is a
potent inhibitor of 5-lipoxygenase (5-LOX), a key enzyme in the biosynthesis of
leukotrienes, which are compounds that cause inflammation. Extracts of
Boswellia appear to have a variety of other biochemical effects, including
inhibiting matrix metalloproteinases (MMP-3s), enzymes that break down
cartilage, collagen and connective tissues (Roy, Antioxid Redox Signal 2006; Sengupta, Arthritis Res Ther 2008).
Boswellia resin and
extracts have shown benefit in reducing symptoms of osteoarthritis and
ulcerative colitis. One study found that capsules
containing a combination of Boswellia and curcumin (Curamin --
350 mg curcuminoids and 140 mg boswellic acid, not tested in this Review) were
modestly effective in reducing pain related symptoms of knee osteoarthritis and
were slightly more effective than curcumin alone in improving physical
function. The capsules were taken three times a day (Haroyan, BMC Compl Alt Med 2018).
A study in India among 48
men and women with knee osteoarthritis found that a boswellic extract taken
twice daily for four months reduced knee pain and stiffness and improved
physical function, compared to placebo. X-ray imaging showed that those who
took the boswellia had a significant increase in the knee joint space and a
decrease in bone spurs relative to those who took the placebo (in whom knee
joint space decreased due to loss of cartilage). The boswellic extract used in
the study (Boswellin by Sabinsa, which funded the study) contained
87.3 mg of total boswellic acids including 53.27 mg of AKBA per tablet, and one
tablet was taken twice daily. The participants did not take other medications
to treat osteoarthritis during the study. No serious adverse events were
reported (Majeed, Phytother Res 2019). This extract is
not an ingredient in any of the products tested in this review, but is sold as
an ingredient in Natures Plus Herbal Actives Boswellin, which
provides slightly more (195 mg) total boswellic acids per capsule (of which
about 119 mg are likely AKBA) than the daily dose used in this study. However,
several products tested in our review (see 4th column of Results table) can provide amounts of AKBA
similar to the 53.27 mg per dose used in the study — but this would generally
require a doubling or more of suggested serving sizes.
Preliminary studies
suggest possible benefit in asthma, Crohn's disease, and cancer. Studies in
rheumatoid arthritis have yielded mixed results.
Turmeric:
Curcuminoids and other compounds in turmeric provide an anti-inflammatory
effect that may provide modest benefit in rheumatoid arthritis and
osteoarthritis, although no better than anti-inflammatory medicines. The
typical daily dose ranges from 500 mg to 2,000 mg of curcuminoids (most of
which is curcumin) from turmeric extracts, which may be as much as
95% curcuminoids. Products that have shown benefit are typically formulated for
enhanced absorption, as curcuminoids are otherwise not well absorbed unless
taken with meal containing fats. For more details, see the What It Does section
of the Turmeric and Curcumin Supplements Review.
Collagen:
Collagen supplementation for at least three to six months may, at best,
modestly reduce joint stiffness and/or pain according to several preliminary
studies using various forms of collagen, including undenatured collagen,
hydrolyzed collagen (collagen hydrolysate or collagen peptides), and eggshell membrane
hydrolysates. Some studies have shown no benefit. For more details see the
Joint Pain section of the Collagen Supplements Review.
Quality Concerns and
Tests Performed:
Glucosamine and Chondroitin:
Although prior testing has shown the vast majority of glucosamine products to
meet label claims, glucosamine from shellfish such as shrimp and crabs may
potentially be contaminated with lead. Chondroitin, on the other hand, is an
ingredient with which ConsumerLab.com has found problems in the past – with
products not always providing the listed amount of this expensive ingredient.
During the 1990s, there
was concern with bovine (cow) sources of chondroitin due to Mad Cow disease
(known scientifically as bovine spongiform encephalitis or BSE). However, there
have not been any reported cases of the disease from chondroitin and the risk
seems to be miniscule because the prion thought to be the causative agent of
the disease exists only in very low levels in cartilage; it's most abundant in
nervous and glandular tissues. The issue of BSE, however, may be avoided by
choosing a product made from the cartilage of other animals, such as pigs (now
a common source), chickens, or sharks -- although most products do not list the
source of chondroitin.
Boswellia:
An important distinguishing feature among Boswellia products is the
concentration and amount of boswellic acids, such as AKBA. Consequently, the
amounts of these acids in each product were determined and compared to the
amounts claimed on products or, if no claim was made, expected minimum amounts
based on the amount and type of Boswellia listed. In tests reported in 2016,
ConsumerLab.com found that one product, MD Formulas Hawaii JointAstin,
contained no more than half of the Boswellia extract listed on its label, based
on the amount of boswellic acids found.
Because no government
agency is responsible for routinely testing glucosamine, chondroitin, MSM, and
Boswellia supplements for their contents or quality, ConsumerLab.com
independently purchased and evaluated products to determine whether they
contained the amounts of these ingredients stated on their labels. Products
containing glucosamine and/or chondroitin from a non-bovine source were tested
for lead, and products containing whole herbs or 250 mg per suggested daily
serving of minerals were tested for lead, cadmium, and arsenic.
In addition, all tablets
and caplets (excluding chewable, sublingual or time-release) were tested for
their ability to properly disintegrate ("break-apart").
What CL Found:
Among the 13 supplements ConsumerLab.com selected and tested,
only nine met quality standards and FDA labeling requirements, while three did
not and the status of one was uncertain. Through ConsumerLab.com's
voluntary Quality Certification Program,
in which products undergo the same testing, an additional five products were
found to meet quality standards.
The four products that
could not be approved, all had, or seemed to have, far lower amounts of at
least one key ingredient than claimed. For the first three products listed
below, these deficiencies were confirmed in tests in a second independent
laboratory:
·
1MD MOVEMD contained only 43.9% of the collagen it claimed to provide
from a combination of eggshell membrane and type II chicken collagen, although
it did contain its claimed amount of AKBA from Boswellia.
·
Standard Process MediHerb Boswellia Complex M1152 contained only
50.9% of its claimed boswellic acids, although it did provide its expected
amount of curcuminoids from turmeric.
·
Vimerson Health Glucosamine Chondroitin Turmeric & MSM contained only 1.8%
of its claimed amount of boswellic acids and only 6.2% of its listed amount of
curcuminoids from turmeric extract, although it did provide its claimed amounts
of glucosamine, chondroitin, and MSM.
·
Nature's Nutrition Joint Support Gummies yielded only 55.2%
of its claimed amount of glucosamine sulfate when tested. Confirmation testing
in second lab could not be performed due to difficulty testing the gummy
formulation. However, even the claimed amount of glucosamine per daily serving
(2 gummies) is not a clinically relevant dose for joint health.
Differences in Product
Formulas:
As shown in the table below, the ingredients in joint health products differ
greatly, as do the amounts of these ingredients — with some providing
clinically relevant dose and others providing less.
Cost:
While joint health
supplements can be compared in terms of their price (which is shown, per
serving, in the 5th column of the
results table), this is not a completely fair comparison because the types and
amounts of ingredients in them are often quite different. However, as most
products include glucosamine, which has some of the best evidence of benefit
for joints, the graph below compares the cost to obtain a standard dose of
1,500 mg of glucosamine HCl (or equivalent amount of glucosamine sulfate) in
products. This cost ranged from just 16 cents (Member's Mark) to $9.07 (Nature's
Nutrition Joint Support Gummies). Cost tended to be higher for products
providing multiple ingredients or forms of delivery other than standard
capsules or tablets, such as gummies.
Interestingly, two
of the costliest products in terms of getting glucosamine failed to pass our
testing: Vimerson ($1.25) and Nature's Nutrition ($9.07).
Top Picks:
Although
there are many combination products on the market — and many were approved for
quality in our tests — it may be better to try individual ingredients first, to
determine which help you and whether they cause side effects (although if you
are interested in using glucosamine or chondroitin, these may work better
together). Keep in mind that the cost of supplements for joint health varies
considerably — and paying more doesn't necessarily mean you are getting a
better product. Below, we list our Top Picks among Approved
products, starting with single-ingredient products, followed by combinations:
If you want glucosamine, it turns out that the least
expensive way to get a standard daily dose of 1,500 mg of glucosamine HCl was
from combination products with chondroitin, as in Member's
Mark [Sam's Club] Triple Strength Glucosamine Chondroitin which
costs 16 cents for a 2-tablet daily serving and is our Top Pick for
Glucosamine as well as our Top Pick for Glucosamine and
Chondroitin. It includes 1,200 mg of chondroitin sulfate sodium. Kirkland
Signature [Costco] sells a similar product, its Extra Strength
Glucosamine Chondroitin, for 4 cents more per day. Also Approved, but more
expensive, is Cosamin DS for Joint Health. Although the amounts and
forms of glucosamine and chondroitin listed in all three products are the
same, Cosamin DS is the only one that has been clinically
tested. It sells for 71 cents per day for its initial suggested dose of 3
capsules daily, but indicates that this may be reduced to a lower maintenance
dose.
You'll actually have to
pay more if you want only glucosamine from the products we reviewed. For the
most extensively tested type of glucosamine (glucosamine HCl — as found in the
two products above), the least expensive product was DEVA
Glucosamine (37 cents for 3 tablets providing a total of 1,500 mg
of glucosamine HCl), which is our Top Pick for glucosamine-only.
The glucosamine in Deva is derived from corn rather than the
more typical crab shell and, therefore, is suitable for use by vegans and
vegetarians. Although not as well-studied for osteoarthritis, the
N-acetyl-D-glucosamine (NAG) form of glucosamine is found in Jarrow
Formulas N-A-G, which provides 700 mg of NAG per veggie cap for 20 cents
with a suggested daily serving of one to two capsules.
As there is not as much supporting evidence for using
chondroitin, MSM, or Boswellia, alone, we did not test products that contained
these as single ingredients. (However, if you want only MSM, NOW MSM
Powder was Approved in our tests in 2018 and provided MSM at a very
reasonable cost -- 6 cents per ½ teaspoon yielding 1,800 mg of MSM. If you
prefer a pill, Doctor's Best MSM 1500 was tested and Approved
in 2016 — it's 7 cents per 1,500 mg tablet).
If you want MSM
with glucosamine and chondroitin, our Top Pick is Doctor's
Best Glucosamine Chondroitin MSM with OptiMSM. For 36 cents you'll get
a daily serving of 4 capsules providing 1,500 mg of glucosamine sulfate 2KCl,
1,200 mg of chondroitin sulfate, and 1,000 mg of MSM. Schiff Move Free
Joint Health Advanced Plus MSM is about the same price per daily
serving (38 cents) but provides a lot less chondroitin sulfate (only 200 mg).
When buying Boswellia you really need to
know the amount of AKBA in the product, as this is believed to be the
active component. However, AKBA is rarely listed on the label. Only 1% of a
Boswellia "resin" product is likely to be AKBA, while 6% to 40% of a
Boswellia "extract" will be AKBA. Because we tested for AKBA, we show
the amounts in each product in the Results table. Clinical studies suggest
benefits with daily doses of Boswellia providing about 7 to 75 mg of AKBA.
Three Approved products
provide Boswellia along with glucosamine and other ingredients: LifeExtension
ArthroMax, Osteo Bi-Flex, and Finest Nutrition Triple
Strength Glucosamine and Chondroitin Complex. Among these,
we would eliminate Finest Nutrition, as it provides only a very
small amount of AKBA (we found only 2.9 mg). LifeExtension ArthroMax and Osteo
Bi-Flex provide, respectively, 20 mg and 25 mg of AKBA and they cost
about the same — respectively, 75 cents and 72 cents per daily serving.
However, our Top Pick for Boswellia with Glucosamine is Life
Extension ArthroMax because it also contains a clinically
meaningful amount (40 mg) of undenatured collagen, NT2, which may
also help with joint pain.
There was only one
Approved product that included turmeric, USANA Procosa. It is
fairly expensive ($1.33 per daily serving of 3 tablets), providing 1,500 mg of
glucosamine HCl and includes 247 mg of Meriva, a bioavailability-enhanced
turmeric extract, providing about 45 mg of curcuminoids. However, this is a
fairly small dose of curcuminoids (dosing is typically about four times that
amount). Consequently, we do not have a Top Pick for turmeric in
a joint supplement. However, you can find other turmeric and curcumin products
in our Turmeric and Curcumin Supplements Review,
including a product providing 1,000 mg of Meriva (and 190 mg of curcuminoids).
Test Results by Product:
Listed
alphabetically within each product group below are test results for 18
supplements of which ConsumerLab.com selected 13. Five were tested at the
request of their manufacturers/distributors through CL's Quality Certification Program and
are included for having passed testing (they are marked with a CL flask).
Shown for each product
are the claimed amounts of glucosamine, chondroitin, MSM, Boswellia, turmeric,
and collagen and the suggested daily serving on its label. Also shown are our
test results for these ingredients if amounts were claimed and, if applicable,
heavy metals and pill disintegration. Price and cost comparisons are shown in
the 5th column, and
additional notable ingredients are shown in the 6th column. A full list of ingredients is
found in the last column. Products that passed all tests are indicated as
Approved; if a product failed testing, the reason is explained in red text.
A separate review
of Joint Health Supplements for Dogs and Cats is
available.
Results of
ConsumerLab.com Testing of Joint Health Supplements
(Glucosamine, Chondroitin, MSM, Boswellia, Collagen and
Turmeric)
(Click arrows or swipe left or right to see all columns)
Approval Statusⓘ
Product Name
Claimed Amount Key Ingredientsⓘ
Heavy Metalsⓘ
Disintegrationⓘ
(NA = Not Applicable)
Pill Sizeⓘ
Suggested Serving on Label
Cost for Suggested Serving
Price
Notable Features
Full List of Ingredients Per Serving
Glucosamine Only Products: (Including NAG)
APPROVED
Top Pick
for glucosamine-only
Deva® Vegan Glucosamine 
Dist. by Deva Nutrition LLC
3 tablets
1,500 mg glucosamine HCl
✔
Heavy
Metals: PassL
Disintegration: Pass
Medium/large tablet
For adults, take three (3) tablets daily with food, or as directed by a doctor.
$0.37/3 tablets
$10.99/90 tablets
Vegan. Non-Shellfish. Food Sensitivity: Free of
yeast, gluten, wheat, soy, shellfish, sugar, animal products, byproducts or
derivatives.
3 tablets
Glucosamine HCl 1,500 mg.
Other Ingredients: Cellulose, vegetable stearic acid, vegetable magnesium
stearate, dicalcium phosphate, croscarmellose sodium, silica, more...
APPROVED
Jarrow Formulas® N-A-G
Dist. by Jarrow Formulas®
1 veggie cap
700 mg N-Acetyl-D-Glucosamine
✔
Heavy
Metals: PassL
Disintegration: NA
Large veggie cap
Take 1 capsule 1 to 2 times per day or as directed by your qualified healthcare
professional.
$0.20/veggie cap
$23.95/120 veggie caps
Salt Free. Suitable for vegetarians/ vegans.
1 veggie cap
N-Acetyl-D-Glucosamine 700 mg.
Other Ingredients: Vegetarian capsule (hydroxypropyl-methylcellulose, water),
cellulose, magnesium stearate (vegetable source) and silicon dioxide.
UNCERTAIN
Nature's Nutrition Joint Support Gummies
Dist. by Nature's Nutrition
2 gummies
160 mg glucosamine sulfate
Found only
88.3 mg (55.2% of listed amount), but unable to confirm deficiency in 2nd lab
due to specific formulation
Heavy
Metals: PassL
Disintegration: NA
Large berry shaped gummy
Take two (2) gummies once a day.
$0.42/2 gummies
$24.92/120 gummies
Sodium 20 mg & vitamin E 10 mg per 2 gummies
Precaution: Contains: Shellfish (Shrimp & Crab).
2 gummies
Calories 18, Total Carbohydrates 5 g, Sodium (as Sodium Citrate) 20 mg, Total
Sugars [Includes Added Sugars 5 g] 5 g, Vitamin E (as DL-Alpha-Tocopheryl
Acetate) 10 mg, Glucosamine Sulfate 160 mg, more...
COMBINATION PRODUCTS
Glucosamine and Chondroitin Combination
Products:
APPROVED
Cosamin® DS for Joint Health®
Dist. by Nutramax® Laboratories Consumer Care,
Inc.
3 capsules
1,500 mg glucosamine HCl
✔
1,200 mg sodium chondroitin sulfate
✔
Heavy
Metals: PassL
Disintegration: NA
Large capsule
Take 3 capsules daily until desired comfort is reached. May reduce number of
capsules taken daily to maintain comfort level.
$0.71/3 capsules
$49.95/210 capsules
Vitamin C 6 mg & manganese 1 mg per 3 capsules
NSF Contents Certified seal. Gluten-Free.
3 capsules
Calories 10, Sodium 70 mg, Total Carbohydrates 2 g, Vitamin C (as Manganese
Ascorbate) 6 mg, Manganese (as Manganese Ascorbate) 1 mg, Glucosamine HCl 1,500
mg, Sodium Chondroitin Sulfate (Contains approximately 8% moisture) 1,200 mg, more...
APPROVED
Kirkland Signature™ [Costco] Extra Strength
Glucosamine 1,500 mg Chondroitin 1,200 mg
Dist. by Costco Wholesale Corporation
2 tablets
1,500 mg glucosamine HCl
✔
1,200 mg chondroitin sulfate sodium
✔
Heavy
Metals: PassL
Disintegration: Pass
Large tablet
Adults - Take two (2) tablets, daily, preferably with a meal.
$0.20/2 tablets
$21.49/220 tablets
Sodium 135 mg per 2 tablets
USP Dietary Supplement Verified® seal. No Preservatives Added. No Artificial
Colors. No Yeast or Gluten. No Lactose.
Precaution: Contains: Shellfish (Crab, Crayfish, Lobster, and
Shrimp).
2 tablets
Calories 10, Total Carbohydrate 2 g, Sodium 135 mg, Glucosamine Hydrochloride
1,500 mg, Chondroitin Sulfate Sodium 1,200 mg.
Ingredients: Glucosamine Hydrochloride, Chondroitin Sulfate Sodium, more...
APPROVED
Top Pick
for glucosamine and chondroitin
Member's Mark [Sam's Club] Glucosamine HCl 1,500
mg Chondroitin Sulfate Sodium 1,200 mg
Dist. by Sam's West, Inc.
2 tablets
1,500 mg glucosamine HCl
✔
1,200 mg chondroitin sulfate sodium
✔
Heavy
Metals: PassL
Disintegration: Pass
Large tablet
Adults - Two tablets daily with food as a dietary supplement.
$0.16/2 tablets
$26.78/340 tablets
Sodium 105 mg per 2 tablets
No Synthetic Dyes. No Artificial Flavors. No Gluten. No Lactose.
Precaution: Contains: Crustacean Shellfish (crab, shrimp).
2 tablets
Calories 10, Total Carbohydrate 3 g, Sodium 105 mg, Glucosamine Hydrochloride
1,500 mg, Chondroitin Sulfate Sodium 1,200 mg.
Ingredients: Glucosamine Hydrochloride, more...
Glucosamine and MSM Combination Products:
APPROVED
Advocare Joint Promotion®
Dist. by AdvoCare® International, LLC
3 capsules
1,500 mg Glucosamine (as HCl)
✔
100 mg MSM
✔
Heavy
Metals: PassL
Disintegration: NA
Large capsule
Take 3 capsules up to twice a day with a meal.
$1.30/3 capsules
$38.95/90 capsules
Manganese 3 mg, Gotu kola extract 100 mg & White willow
extract 30 mg per 3 capsules
Informed Sport We Test You Trust seal.
Precaution: Contains: Shellfish (Crab, Lobster, Shrimp).
3 capsules
Manganese (as manganese sulfate) 3 mg, Glucosamine (as HCl) 1,500 mg, Gotu kola
extract (leaf/steam/flower - Centella asiatica) 100 mg, MSM
(methylsulfonyl-methane) 100 mg, White willow extract (bark - Salix
alba) 30 mg, more...
Glucosamine and Turmeric Combination Products:
APPROVED
USANA Procosa®
Mfd. by USANA Health Sciences, Inc.
3 tablets
1,500 mg glucosamine HCl
✔
247 mg turmeric extract (Meriva® Bioavailable Curcumin Complex)
49.4 mg curcuminoids (expected minimumⓘ)
✔
Found: 45.2 mg curcuminoids
Heavy
Metals: PassL
Disintegration: Pass
Medium/large tablet
Adults take three (3) tablets daily, preferably with food.
$1.33/3 tablets
$37.35/84 tablets
Vitamin C 225 mg, magnesium 44 mg, manganese 5 mg & potassium
94 mg per 3 tablets
3 tablets
Vitamin C (as Calcium Ascorbate) 225 mg, Magnesium (as Magnesium Sulfate) 44
mg, Manganese (as Manganese Gluconate) 5 mg, Potassium (as Potassium Sulfate)
94 mg, more...
Boswellia and Collagen Combination Products:
NOT APPROVED
1MD® MoveMD™
Dist. by 1MD™
1 capsule
100 mg Boswellia extract (ApresFlex®) providing 20 mg AKBA (expectedⓘ)
✔
Found: 25.5 mg AKBA
100 mg type X.I.V. eggshell membrane collagen and 280 mg type II
chicken collagen providing a total of 268 mg collagen
Found only
117.6 mg (43.9% of listed amount)
Heavy
Metals: NA
Disintegration: NA
Large capsule
Adults take one (1) capsule daily, with or without food, or as recommended by a
healthcare professional.
$0.62/capsule
$112.00/six bottles of 30 capsules (180 capsules total)
Zanthin® natural astaxanthin 2 mg & hyaluronic acid 25 mg per
capsule
Gluten-Free. Soy-Free. Preservatives-Free. Not manufactured with wheat,
gluten, fish or shellfish ingredients. Produced in a GMP facility that
processes other ingredients containing these allergens, more...
1 capsule
ApresFlex® Boswellia Serrata Extract 100 mg, Zanthin® Natural Astaxanthin 2 mg,
Type X.I.V. Eggshell Membrane Collagen 100 mg, Type II Chicken Collagen 280 mg,
Hyaluronic Acid 25 mg, more...
Boswellia and Turmeric Combination Products:
NOT APPROVED
Standard Process® MediHerb® Boswellia Complex
M1152
Mfd. by MediHerb
1 tablet
277 mg Boswellia gum oleoresin 7:1 extract (from 1.9 g Boswellia gum oleoresin)
providing 180 mg of boswellic acids
Found only
91.6 mg (50.9% of listed amount), yielding 2.2 mg AKBA
250 Turmeric rhizome 25:1 extract (from 2.0 g turmeric rhizome) providing 70.4
mg curcuminoids
✔
Heavy
Metals: NA
Disintegration: Pass
Medium/large tablet
1 tablet 2-4 times daily, or as directed.
$0.72/tablet
$28.60/40 tablets
Celery seed fruit 6:1 extract 166.7 mg & ginger rhizome 10:1
extract 30 mg per tablet
1 tablet
Calories 5, Boswellia gum oleoresin 7:1 extract [from Boswellia serrata gum
oleoresin 1.9 g, Containing boswellic acids 180 mg] 277 mg, Celery Seed fruit
6:1 extract [from Apium graveolens fruit 1.0 g] 166.7 mg, Ginger rhizome 10:1
extract [from Zingiber officinale rhizome 300 mg] 30 mg, more...
Glucosamine, Chondroitin and MSM Combination
Products:
APPROVED
California Gold Nutrition® Total Veggie Joint
Dist. by Madre Labs, LLC
2 veggie capsules
750 mg glucosamine sulfate 2KCl
✔
200 mg chondroitin sulfate sodium (Mythocondro®)
✔
500 mg MSM (OptiMSM®)
✔
Heavy
Metals: PassL
Disintegration: NA
Large veggie capsule
Take 2 capsules daily with or without food.
$0.36/2 veggie capsules
$16.00/90 veggie capsules
Chloride 90 mg, sodium 20 mg, potassium 100 mg & hyaluronic
acid 50 mg per 2 veggie capsules
No Animal-Derived Ingredients. No Gluten. No GMOs. No Soy. This product is
not manufactured with milk, more...
2 veggie capsules
Chloride (from Glucosamine Sulfate 2KCl) 90 mg, Sodium (from Mythochondro®
& Sulfate Hyaluronate) 20 mg, Potassium (from Glucosamine Sulfate 2KCl) 100
mg, more...
APPROVED
Top Pick
for glucosamine and chondroitin with MSM
Doctor's Best® Glucosamine Chondroitin MSM with
OptiMSM
Dist. by Doctor's Best, Inc.
4 capsules
1,500 mg glucosamine sulfate 2KCl
✔
1,200 mg chondroitin sulfate
✔
1,000 mg MSM (OptiMSM®)
✔
Heavy
Metals: PassL
Disintegration: Pass
Large capsule
Take 4 capsules daily with food, or as recommended by a nutritionally-informed
physician.
$0.36/4 capsules
$21.34/240 capsules
Chloride 180 mg, sodium 85 mg & potassium 180 mg per 4
capsules
Non-GMO/ Gluten Free/ Soy Free.
Precaution: Contains shellfish (crab and shrimp shells).
4 capsules
Chloride (from glucosamine sulfate 2KCl) 180 mg, Sodium (from chondroitin
sulfate sodium) 85 mg, Potassium (from glucosamine sulfate 2KCl) 180 mg,
Glucosamine Sulfate 2KCl 1,500 mg, more...
APPROVED
Nature's Way® Joint Movement Glucosamine Extra
Strength - Berry Flavored
Dist. by Nature's Way Brands, LLC
2 tbsp [30 ml]
2,000 mg glucosamine HCl
✔
1,200 mg chondroitin sulfate
✔
500 mg MSM
✔
Heavy
Metals: PassL
Disintegration: NA
Taste: Very sweet, sour, somewhat thick consistency.
Take 2 Tablespoons (1 fluid ounce) daily either directly or mix into water or
juice.
$0.69/2 tbsp (1 fl oz)
$10.99/16 fl oz [480 ml] bottle (approx. 16 servings)
Vitamin D3 10 mcg (400 IU), sodium 100 mg & hyaluronic acid 10
mg per 2 tbsp
Sugar Free. Gluten Free. Shellfish Free.
2 tbsp
Calories 30, Total Carbohydrate 7 g, Dietary Fiber <1 g, Total Sugars
[Includes 0 g Added Sugars] 0 g, Sugar Alcohol 3 g, Vitamin D3 (as
cholecalciferol) 10 mcg (400 IU), Sodium 100 mg, Glucosamine HCl 2,000 mg, more...
APPROVED
Schiff® Move Free® Joint Health Advanced Plus
MSM
Dist. by RB Health (US) LLC
3 coated tablets
1,500 mg glucosamine hydrochloride
✔
200 mg chondroitin sulfate
✔
1,500 mg MSM
✔
Heavy
Metals: PassL
Disintegration: NA
Medium/large coated tablet
Adults take three (3) tablets once a day with a meal OR one (1) tablet three
times daily with meals.
$0.38/3 coated tablets
$15.29/120 coated tablets
Sodium 20 mg, hyaluronic acid 3.3 mg & calcium fructoborate
216 mg per 3 coated tablets
Precaution: Contains Shellfish (Shrimp, Crab, Lobster, And
Crayfish).
3 coated tablets
Calories 5, Total Carbohydrate 2 g, Sodium 20 mg, Glucosamine Hydrochloride
1,500 mg, Chondroitin Sulfate 200 mg, Hyaluronic Acid 3.3 mg, Calcium
Fructoborate 216 mg, MSM (Methylsulfonyl-methane) 1,500 mg, more...
Glucosamine, Boswellia and Collagen
Combination Products:
APPROVED
Top Pick
for glucosamine with Boswellia and collagen
Life Extension® ArthroMax® Advanced NT2
Collagen™ & ApresFlex®
Dist. by Quality Supplements and Vitamins, Inc.
2 capsules
1,500 mg glucosamine sulfate 2KCl
✔
100 mg Boswellia extract (ApresFlex®) providing 20 mg AKBA
✔
10 mg collagen (from NT2 Collagen® standardized cartilage 40 mg)
✔
Heavy
Metals: PassL
Disintegration: NA
Large capsule
Take two (2) capsule daily with food, or as recommended by a healthcare
practitioner.
$0.75/2 capsules
$22.47/60 capsules
Boron 1.5 mg per 2 capsules
Gluten Free. No GMO.
2 capsules
Glucosamine sulfate 2KCl (derived from corn) 1,500 mg, ApresFlex® Indian
frankincense (Boswellia serrata) extract (gum resin) [std. to 20% AKBA] 100 mg,
NT2 Collagen™ standardized cartilage [providing 10 mg total collagen] 40 mg,
Boron (calcium fructoborate as patented FruiteX B® OsteoBoron®) 1.5 mg, more...
Glucosamine, Chondroitin, MSM and Boswellia
Combination Products:
APPROVED
for glucosamine and Boswellia
Osteo Bi-Flex® Triple Strength + Vitamin D
Mfd. by Rexall Sundown, Inc.
2 coated tablets
1,500 mg glucosamine HCl
✔
100 mg Boswellia extract (Joint Shield™ 5-LOXIN Advanced®) providing 30 mg AKBA
(expectedⓘ)
✔
Found: 25.6 mg AKBA
275 mg chondroitin/MSM complex containing chondroitin sulfate and
MSM
Heavy
Metals: PassL
Disintegration: Pass
Medium/large coated tablet
Directions For Adult Use: Take Two (2) Tablets Per Day Preferably With Food.
$0.72/2 coated tablets
$43.49/120 coated tablets
Vitamin D 50 mcg (2,000 IU) & sodium 20 mg per 2 coated
tablets
Free of Gluten. Non-GMO.
Precaution: Contains Shellfish (crab, crayfish, lobster, shrimp)
ingredients.
2 coated tablets
Calories 10, Total Carbohydrate 2 g, Vitamin D (as D3 Cholecalciferol) 50 mcg
(2,000 IU), Sodium 20 mg, Glucosamine HCl 1,500 mg, Joint Shield™ 5-LOXIN
Advanced® [Boswellia serrata Extract (resin)] 100 mg,
Chondroitin/MSM Complex [Chondroitin Sulfate, Methylsulfonyl-methane (MSM)] 275
mg, more...
Glucosamine, Chondroitin, MSM and Turmeric
Combination Products:
NOT APPROVED
Vimerson Health® Glucosamine Chondroitin
Turmeric & MSM
Dist. by Vimerson Health®
3 capsules
1,500 mg glucosamine sulfate sodium
✔
150 mg chondroitin sulfate
✔
200 mg Boswellia extract (65% boswellic acid), providing 130 mg of boswellic
acid
Found only
2.3 mg boswellic acids (1.8% of listed amount), yielding 0.3 mg AKBA
150 mg turmeric 4:1 extract providing a minimum of 30 mg curcuminoids (expectedⓘ)
Found only
9.3 mg (6.2% of listed amount)
25 mg MSM
✔
Heavy
Metals: PassL
Disintegration: NA
Large capsule
Take three (3) capsules together before a meal, or as directed by your
healthcare professional. The highest dose we recommend is a maximum of three
(3) capsules taken together, twice per day. For those with a more sensitive
constitution, we recommend taking one (1) capsule from one to three times per
day before a meal.
$0.90/3 capsules
$26.87/90 capsules
Quercetin 25 mg, L-methionine 25 mg & bromelain 25 mg per 3
capsules
100% Natural, GMO Free, Gluten Free, Dairy Free. Zero Hormones, Antibiotics,
Preservatives, Soy, Yeast, Sugar, Artificial Ingredients/ Flavors.
3 capsules
Glucosamine Sulfate Sodium (Shellfish-Free) 1,500 mg, Boswellia Extract 65%
Boswellic Acid (Boswellia carteri, Bark) 200 mg, Chondroitin Sulfate 150
mg, Turmeric 4:1 Extract (Curcuma longa, Root) 150 mg, Quercetin
(Sophora japonica, Buds) 25 mg, L-Methionine 25 mg, Methylsulfonyl-methane
(MSM) 25 mg, Bromelain (Ananas comosus, Stem) 25 mg.
Other Ingredients: Gelatin Capsule.
Glucosamine, Chondroitin, MSM, Boswellia and
Collagen Combination Products:
APPROVED
Finest Nutrition® [Walgreens] Triple Strength
Glucosamine and Chondroitin Complex
Dist. by Walgreen Co.
2 tablets
1,500 mg glucosamine HCl
✔
100 mg Boswellia extract providing a minimum of 6 mg β-boswellic acids
(expectedⓘ)
✔
Found: 7.5 mg
β-boswellic acids, yielding 2.9 mg AKBA
1,103 mg chondroitin/ MSM complex containing chondroitin sulfate,
MSM, Boswellia extract and collagen
Heavy
Metals: Pass
Disintegration: Pass
Large tablet
Adults - Two tablets daily with food as a dietary supplement.
$0.50/2 tablets
$29.99/120 tablets
Vitamin C 60 mg, manganese 2 mg, sodium 30 mg, boron (in
chondroitin/ MSM complex, no amount listed), hyaluronic acid (in chondroitin/
MSM complex, no amount listed)
No Artificial Dyes Or Flavors, No Gluten, No Lactose.
Precaution: Contains Crustacean shellfish (crab, shrimp).
2 tablets
Calories 10, Total Carbohydrate 2 g, Vitamin C 60 mg, Manganese 2 mg, Sodium 30
mg, Glucosamine Hydrochloride 1,500 mg, Boswellia serrata Extract
(resin) 100 mg, Chondroitin/ MSM Complex [Chondroitin Sulfate,
Methylsulfonyl-methane (MSM), Collagen (Hydrolyzed Gelatin), Boswellia
serrata Extract (resin), more...
Unless otherwise noted, information about the
products listed above is based on the samples purchased by ConsumerLab.com (CL)
for this Product Review. Manufacturers may change ingredients and label
information at any time, so be sure to check labels carefully when evaluating
the products you use or buy. If a product's ingredients differ from what is
listed above, it may not necessarily be of the same quality as what was tested.
The information contained in this report is
based on the compilation and review of information from product labeling and
analytic testing. CL applies what it believes to be the most appropriate
testing methods and standards. The information in this report does not reflect
the opinion or recommendation of CL, its officers or employees. CL cannot
assure the accuracy of information.
Copyright ConsumerLab.com, LLC, 2021 All
rights reserved. Not to be reproduced, excerpted, or cited in any fashion
without the express written permission of ConsumerLab.com LLC
ConsumerTips™:
Glucosamine and Chondroitin:
Glucosamine in supplements can be purchased in different chemical forms.
Glucosamine hydrochloride (HCl) is the form that has been used
most often in studies where glucosamine is combined with chondroitin.
Glucosamine sulfate (more correctly called glucosamine sulfate
2-KCl -- the KCl stands for potassium chloride) or glucosamine sulfate
2-NaCl (the NaCl stands for sodium chloride) are the forms that have
been used most often when glucosamine alone has been studied. There appears to
be no conclusive evidence that one form is better than another. However, the
amount of true (or "free") glucosamine per gram of each compound
varies greatly. In fact, 1,500 mg of glucosamine hydrochloride actually yields
1,246 mg of free glucosamine while 1,500 mg of glucosamine sulfate with 2-NaCl
or 2-KCl yield, respectively, only 938 mg or 888 mg of free glucosamine.
Although the hydrochloride form provides more free glucosamine than the sulfate
forms, 1,500 mg per day of either form appears to be effective. People watching
their salt intake may, however, want to avoid products made with the form that
includes NaCl (sodium chloride) -- if a label states only glucosamine sulfate,
it could be either form, so look specifically for products stating glucosamine
sulfate 2-KCl.
Chondroitin is typically
sold as chondroitin sulfate, which is also the form that's been used in most
studies. About 1,200 mg of chondroitin sulfate is recommended per day.
Chondroitin sulfate is usually in a salt form to help stabilize it, so don't be
concerned if you see "sodium chondroitin sulfate" (or
"chondroitin sulfate sodium) on the label. These are the complete chemical
names — although not all manufacturers use them — and the active ingredient,
chondroitin sulfate, is the same. Supplement labels typically list the amount
of chondroitin sulfate in the product, but some may include the relatively
small weight of the attached sodium, representing about 5% of the total weight.
For example, a label indicating 1,200 mg of chondroitin sulfate (as sodium
chondroitin sulfate) should provide 1,200 mg of chondroitin sulfate, while a
label indicating 1,200 mg of sodium chondroitin sulfate should provide about
1,100 mg of chondroitin sulfate.
Be
aware that 1,200 mg of chondroitin sulfate from the sodium salt
form will contribute about 100 mg per day of sodium. To reduce your sodium
intake, consider products made with the calcium salt form.
With that form you'll add about 191 mg of calcium per day to your diet instead
of sodium.
Chondroitin can vary in
terms of its purity, which tends to range from about 80% to 90%. The GAIT study
sponsored by the NIH used chondroitin sulfate made by Bioberica which is
believed to be 95% pure. The manufacturer of CosaminDS (a
glucosamine/chondroitin combination product which is Approved in this Review)
claims to be the exclusive licensee for this form of chondroitin. Chondroitin
can also vary in terms of the chain length (and molecular weight) of its
components — although the clinical significance of this is not well known. Results
of laboratory studies with cell cultures indicate that shorter length molecules
are better absorbed, but it is possible that longer length molecules are also
digested to shorter length units. It is, therefore, difficult to say whether
either form works better than the other.
Some products mention in
their labeling that they contain chondroitin A, which is a subcomponent of the
larger chondroitin polysaccharide. This is probably of little importance. All
chondroitin from cow or pig sources contains combinations of chondroitin A (or
chondroitin 4 sulfate), chondroitin C (or chondroitin 6 sulfate) and a
non-sulfated component.
Both glucosamine and
chondroitin are typically taken in divided doses throughout the day (that is,
500 mg of glucosamine HCl or sulfate and 400 mg of chondroitin sulfate three
times per day or 750 mg glucosamine HCI or sulfate and 600 mg chondroitin
sulfate two times per day). Because the amount of glucosamine or chondroitin
per pill varies across products, the number of pills needed daily varies and
this should be considered when comparing the costs of products. One large,
successful study used a single daily dose of 1,500 mg of glucosamine sulfate
and 800 mg of chondroitin sulfate (LEGS study).
For treating symptoms of
osteoarthritis of the hand, 800 mg once daily of a highly purified (95% pure)
chondroitin sulfate has been used (Gabay, Arth & Rheum 2011).
Some
glucosamine-chondroitin products may contain manganese (which may potentially
aid bone formation). The manganese levels in such products typically exceed the
recommended intake, which is 2.3 mg per day for men and 1.8 mg per day for
women — an amount similar to that consumed in the typical American diet. Too
much manganese (over 11 mg per day) for an extended period of time carries a
risk of neurological side effects. While this amount of manganese is not
dangerous if taken just during a few weeks of initial therapy, it should not be
exceeded for an extended period of time.
Beneficial effects from
these products may take anywhere from several weeks to 3 months, and the
products aren't likely to help those with severe osteoarthritis — where
cartilage has worn down so much that bones rub against bones. Losing weight and
switching from high-impact to low-impact sports are also advised for people
with osteoarthritis.
If a positive response is
not experienced within 3 months, continuing with the supplement or increasing
the dose is not indicated. If the supplements are having a beneficial effect,
it may be possible to reduce the dose after the first few months. A person
under 200 lbs. with a positive response to the full dose (1,500 mg glucosamine
and 1,200 mg chondroitin per day) could try reducing the dose to 1,000
glucosamine and 800 of chondroitin. Those under 115 lbs. could try going to 500
glucosamine and 400 chondroitin. If symptoms return, they should return to the
full dosage. Those over 200 lbs. should stay on the full dosage.
MSM:
There are few well-controlled published clinical studies for MSM, so it's
difficult to determine the optimal dose. The most commonly suggested daily dose
is 2 grams. However, recommendations can range from 500 mg to 3 grams (1,000 mg
= 1 gram). Occasionally, recommendations go as high as 8 grams/day.
High-quality MSM is an
odorless white crystalline powder. When improperly manufactured, it can be
contaminated with DMSO, which has a faint sulfur-like or garlic smell. Some
products claim as little as 167 mg of MSM per pill; others, as much as 1,500
mg. When buying an MSM product, consider this variation.
Boswellia:
Boswellia resin should consist of at least 1% boswellic acids, while extracts
of the resin are expected to contain at least 6%. Proprietary extracts are
often standardized to much greater concentrations of boswellic acids or
specific ones such as AKBA, e.g., 5-Loxin (30% AKBA), AprèsFlex (20% AKBA), and
Aflapin (20% AKBA enriched with non-volatile resin oils). These proprietary
extracts may, therefore, be more potent than less concentrated extracts -- so
be sure to carefully check ingredient descriptions in the Supplement Facts panels
on labels.
Boswellic acids such as AKBA are fat soluble and, therefore, not
well absorbed if taken with only water. Absorption may be enhanced
(potentially doubled or more) if taken along with a fatty meal (Sterk, Planta Med 2004;Skarke, J Clin Pharmacol 2012). Formulations
that include oils (such as Alfapin) or that encapsulate AKBA in liposomes or
phytosomes may also enhance absorption of AKBA, as shown in animal experiments
(Sengupta, Mol Cell Biochem 2011; Husch, Fitoterapia 2013).
It has been suggested that the addition to supplements of piperine (a compound
in black pepper sold as Bioperine) may increase the bioavailability of
boswellic acids, but there do not appear to be published studies demonstrating
this.
For treating symptoms of
osteoarthritis, 100 mg or 250 mg of the 5-Loxin brand of Boswellia extract
(which is 30% AKBA) has been shown to provide benefit after 90 days of
treatment, with initial benefit seen in the 250 mg dose group within 7 days of
treatment (Sengupta, Arth Res Ther 2008 ; Sengupta Int J Med Sci 2010). 100 mg daily of
the Aflapin brand has shown similar, if not somewhat greater, benefit. The dose
is typically divided in half and taken twice daily.
An extract consisting of
40% boswellic acids (but just 2% AKBA), given for 8 weeks at a dose of 333 mg
three times daily has also been shown to reduce symptoms of osteoarthritis of
the knee. All patients receiving drug treatment reported a decrease in knee
pain, increased knee flexion, and increased walking distance. Furthermore, the
frequency of swelling in the knee joint was decreased. (Kimmatkar, Phytomedicine 2003).
For
treating symptoms of ulcerative colitis, 300 mg or 350 mg of Boswellia resin
taken three times daily for 6 weeks, have been shown to be as, if not more,
effective as the drug sulfasalazine (1,000 mg three times a day) (Gupta, Eur J Res 1997; Gupta, Planta Med 2001).
Hyaluronic acid
Hyaluronic acid, a natural component of cartilage and synovial fluid (the fluid
around joints) is sometimes added to supplements for joint health. The FDA has
approved hyaluronic acid injections for osteoarthritis, but
the evidence is mixed as to whether it works orally. Two small studies of a
branded hyaluronic acid formula (Hyabest®(J), Kewpie Co.) suggest that
200 mg taken daily for up to two months may improve pain and stiffness in people
with severe knee osteoarthritis pain, but appears to be no more effective than
placebo for those with mild to moderate pain, or when taken for longer periods
of time (Sato, J New Rem & Clin 2009; Tashiro, Sci World J 2012). In a clinical
study of men and women with knee osteoarthritis, a branded formula containing a
combination of hyaluronic acid and collagen, (Hyal-Joint®, Bioiberica)
failed to show any significant benefit compared to placebo (Kalman, Nutr J 2008). However, another study
found that 80 mg of a hyaluronic acid formula (without collagen) (Oralvisc®,
Bioiberica) taken daily for 3 months significantly reduced pain and stiffness
and blood markers of inflammation in overweight and obese men and women with
knee osteoarthritis compared to placebo (Nelson, Rheumatol Int 2015). Interestingly,
those taking the hyaluronic acid also had a significant decrease in levels of
leptin, a hormone which tends to be elevated in people who are obese.
If you want to try
hyaluronic acid, it's best to take amounts used in clinical studies (between 80
mg and 200 mg hyaluronic acid per daily serving), which are typically found in
supplements that only contain hyaluronic acid. Be aware that hyaluronic acid is
sometimes added on its own or part of a "formula" or
"blend" in joint health supplements containing other ingredients,
such as some glucosamine and chondroitin supplements in this review, (see the
last column of the results table above for "Other Notable
Ingredients"), but typically not in clinically meaningful amounts — just a
few milligrams per serving. Some joint supplements contain a "propriety
blend" containing hyaluronic acid, however, there is no way to know how
much hyaluronic acid the blend contains. When taken as a supplement, hyaluronic
acid appears to be generally safe, although one person in a clinical study
stopped taking it after developing a rash. Rarely, anaphylaxis has been
reported when it is injected. The hyaluronic acid in supplements is extracted
from roosters' combs (the red flesh on top and below the head) or produced from
bacteria.
Turmeric:
The typical daily dose ranges from 500 mg to 2,000 mg of curcuminoids (most of
which is curcumin) from turmeric extracts, which can often be as much as 95%
curcuminoids. Turmeric powder in some supplements is similar to turmeric spice,
which is only about 3% curcuminoids, i.e., one teaspoon of turmeric powder
(about 5,000 mg) provides only about 150 mg of curcuminoids. For more details, see
the Dosage section of the Turmeric and Curcumin Supplements Review.
Collagen:
When using undenatured collagen which is made of cartilage (such as UC-II or,
another branded collagen, NT2) for joint pain, the dose is 40 mg per day
(providing 10 mg of collagen), taken on an empty stomach at bedtime.
Exercise:
Proper muscle strengthening exercises and physical activity can reduce joint
pain and improve function associated with osteoarthritis. A study in Australia
among 206 adults with knee osteoarthritis showed that following a 24-week,
self-administered program of exercise and activity (developed by
physiotherapists at the University of Melbourne) resulted in clinically
important reductions in knee pain in 72.1% of those who followed the program,
which included automated reminder messages. In addition, 68% had clinically
important improvements in knee function (Nelligan, JAMA 2021).
The researchers have made the program free on the internet at https://mykneeexercise.org.au/.
The program consists of three phases of exercise, each lasting about 2 months.
The website explains and demonstrates the exercises. Also free is an online app that sends tailored, weekly
motivational messages.
Concerns and Cautions:
Glucosamine and Chondroitin:
Glucosamine and chondroitin, taken in appropriate amounts, are generally
considered safe for healthy people not taking other medications, but be aware
that, in some individuals, glucosamine can cause gastrointestinal
discomfort, drowsiness, skin reactions, and headache and chondroitin
can occasionally cause stomach upset (Clegg, N Engl J Med 2006).
Glucosamine is an amino sugar, so it may theoretically
affect blood sugar levels. However, studies in people have not
found evidence of such an increase (Scroggie, Arch Intern Med 2003; Anderson, Food Chem Toxicol 2005). In fact,
one study found that 1,500 mg of glucosamine sulfate taken for 3 years slightly
lowered fasting blood sugar levels in older adults with knee
osteoarthritis (Reginster, Lancet 2001). In
addition, a study of nearly half a million adults in the UK found that, over a
period of about 7 years, self-reported use of glucosamine was associated with a
decreased risk of developing type 2 diabetes (Ma, Diabetes Care 2020 —
see theWhat It Does section for more details).
Because
the glucosamine in supplements is commonly derived from shrimp or crab
shells, people allergic to shellfish may experience an allergic
reaction to these products. A vegetable-based glucosamine is now
available, sold under the trademarks Regenasure and GreenGrown.
Glucosamine may increase eye pressure in people with open-angle
glaucoma or ocular hypertension: A small analysis in people with open-angle
glaucoma or ocular hypertension (IOP >21 mm Hg) found that eye pressure
measurements were significantly higher, by about 18%, while taking glucosamine
supplements compared to measurements before taking it. Most patients were
taking 1,500 mg daily of glucosamine (the form of glucosamine, e.g., sulfate or
HCl, was not listed in the study). When glucosamine was discontinued, eye
pressure measurements returned to pre-supplement levels (Murphy, JAMA Ophthalmol 2013).
For people without these conditions (and particularly in
younger people without these conditions) glucosamine may have little to no
ocular effect. For example, an increase in intraocular pressure of 9% was
recorded in a study in which people without glaucoma or ocular hypertension who
took 750 mg of glucosamine sulfate, three times daily, for three months for
osteoarthritis. The risk of a clinically significant rise in pressure of
≥ 2 mm Hg was 2.7 times greater in the glucosamine group compared to
placebo, and the average age of those who experienced this increase was 66,
compared to 58 for those who didn't (Esfandiari, Eye (Lond) 2017). On the other hand, a study in Thailand among 88 men and
women who did not have glaucoma or ocular hypertension found taking glucosamine
sulfate (1,500 mg daily) for knee osteoarthritis for six months did not increase
in ocular eye pressure compared to placebo (Yuenyongviwat, J Fr Ophtalmol 2019).
Chondroitin is similar in
structure to the blood-thinning drug heparin, so use of
chondroitin with blood-thinning drugs or daily aspirin therapy may cause
bleeding in some people. There are also reports of glucosamine and
glucosamine/chondroitin affecting coagulation, increasing the INR
(international normalized ratio) and the risk of bruising or bleeding in people
using warfarin (Coumadin). If you use blood-thinning drugs, be sure to let your
healthcare provider know if you take glucosamine or chondroitin, the dosage,
and if you change the dosage.
Chondroitin sulfate may
aggravate asthma. A worsening of asthma symptoms that persisted for
three weeks even with increased asthma medication was reported in a 52-year-old
woman taking a product containing 500 mg of glucosamine and 400 mg of
chondroitin sulfate three times daily; her symptoms resolved within 24 hours of
stopping supplementation (Tallia, J Am Board Fam Pract 2002).
People with asthma have been found to have elevated levels of antibodies to
chondroitin sulfate in their airways.
Chondroitin sulfate is a
component of a substance called versican that appears to support the spread
of prostate cancer (Sakko, Cancer Res 2003). However, chondroitin
sulfate itself has not been shown to have this effect (Braksy, Nutr Cancer 2011).
If you need to watch your
sodium intake, consider choosing a product that does not use the sodium forms
of glucosamine and chondroitin, as discussed above.
Before starting on any
supplement for joint pain, consult a physician to be sure of your diagnosis.
This is particularly important with hip pain, which may be caused by rheumatoid
arthritis, infection, damaged blood supply, gout or other diseases for which
treatment with glucosamine, chondroitin, or MSM would be inappropriate.
MSM:
MSM is generally safe when taken at recommended dosage levels, but be aware
that MSM occasionally causes nausea, diarrhea, or headache. MSM may also have
an aspirin-like effect and shouldn't be used by patients already taking
blood-thinning drugs, unless medically supervised. The safety of MSM hasn't
been evaluated for children or for women who are pregnant or breast-feeding, so
individuals in these groups should avoid using MSM.
Boswellia:
At the dosage used in the clinical studies
referenced above, boswellia resin and extracts have been well tolerated. Some
patients have reported gastrointestinal side effects, such as diarrhea,
heartburn, nausea, and abdominal pain but this has generally not
caused them to discontinue treatment. Headache, itching, and swelling
of the foot have also been reported (Sengupta, Arthritis Res Ther 2008). There is
one report of an allergic reaction (confirmed with an allergen
patch test) to boswellia when applied topically that resulted in a blistering
rash (Acebo, Contact Dermatitis 2004).
Turmeric:
Turmeric/curcumin supplements are generally safe, but gastrointestinal side
effects may occur with higher doses and they can cause problems for people
with gallbladder disease, kidney stones, or those
taking blood-thinning or blood-sugar-lowering
medications. Rarely, liver injury has been reported. One
of the bioavailability enhancers commonly added can potentially affect a number
of drugs. For more details, see the Concerns and Cautions section of the Turmeric and Curcumin Supplements Review.
Collagen:
Collagen supplements are generally well-tolerated, but mild side effects
including gastrointestinal symptoms, headache, dizziness and rash can
occur. People with allergies to specific sources of collagen
(such as fish) should avoid collagen products derived from these sources. For
more details, see the Concerns and Cautions section of the Collagen Supplements Review.
Information on this site
is provided for informational purposes only. It is not an endorsement of any
product nor is it meant to substitute for the advice provided by physicians or
other healthcare professionals. The information contained herein should not be
used for diagnosing or treating a health problem or disease. Consumers should
inform their healthcare providers of the dietary supplements they take.
Latest Clinical Research Updates for Joint Health Supplements
Glucosamine & Chondroitin – How They May Work
12/07/2019
A recent study suggests
that one way glucosamine and chondroitin may work is through the gut. For
details, see the What It Does section
of the Joint Health Supplements Review (Glucosamine, Chondroitin, MSM and
Boswellia). Also see our Top Picks among products.
5/28/2019
Glucosamine may increase
eye pressure in people with glaucoma or intraocular hypertension. But does it
have this effect in people who don't have these conditions? See what a new
study found in the Concerns and Cautions section of the Joint Health
Supplements Review. Also see our Top Picks for glucosamine and chondroitin.
5/15/2019
Does taking glucosamine
affect your risk of developing cardiovascular disease? See what a large study
recently found in the What It Does section
of the Joint Health Supplements Review (Glucosamine, Chondroitin, MSM and
Boswellia). Also see our Top Picks among joint health supplements.
4/26/2016
A recent clinical trial
evaluated glucosamine with chondroitin versus placebo for reducing pain and
improving function in people with osteoarthritis of the knee. See the details,
along with results of our tests of popular supplements, see our Review of Glucosamine, Chondroitin,
MSM and Boswellia Supplements for Joint Health >>
Glucosamine & Chondroitin Help Maintain Knee Joint
3/08/2014
A 2-year study in people
with osteoarthritis of the knee found that those who took a combination of
glucosamine and chondroitin had only half the amount of narrowing of the knee
joint space as those who took placebo. This beneficial finding differs from
that of another large study published several years ago which did not find a
benefit on joint space. The new study used a different form of glucosamine than
the previous study. Get the details, as well as our tests of supplements with
these ingredients, in the updated Joint Health Supplements Review
(Glucosamine, Chondroitin, MSM and Boswellia) >>
Related CL Answers (18)