SKELETAL HEALTH, SPORTS INJURIES AND
NATURAL THERAPIES
STEPHEN HOLT, MD, MRCP (UK), FRCP (C),
FACP, FACG, FACN
Introduction
Over a lifetime, almost every active individual will sustain some form of injury related to exercise. The past decade has witnessed a progressive increase in the reporting of sports injuries. As people recognize physical activity as an important component of lifestyle, skeletal health and function has become a major area of interest for trainers, chiropractors and physicians. Sports enthusiasts have tended to concentrate often on body sculpting and muscle function at the expense of considering the importance of skeletal health. It is not possible to “build a better body” without attention to “better bones and joints”.
Many “weekend warriors” may run to the gymnasium and “hobble” home. There has been important recognition of the role of nutrition and special formulations of dietary supplements in the healthy pursuit of sport. However, the role of nutrition, herbals and botanicals in the provision of nutritional support for healthy skeletal function has been somewhat forgotten, even by protagonists of natural medicine.
Skeletal Structure and Function
Several types of injury affect amateur and professional athlete . Injuries vary in severity from simple contusion (blunt force) through to bone fractures and major disruption of joints. These latter injuries include strain or rupture of ligaments and damage to cartilage. Although the majority of injuries are minor in nature, these problems lead initially to termination of athletic activity, often with average rehabilitation times of several weeks for mild to moderate injury.
The process of building an ideal muscle mass puts substantial strain on bones, joints and soft tissues. The idea of building muscle mass without building an ideal skeletal framework is very misguided. Recent studies have drawn attention to the common occurrence of osteoporosis (thin bones) and osteoarthritis (common arthritis) in mature adults. Osteoporosis is a key health concern for prevention and treatment in females over the age of 30 years. Some readers may be shocked by the selection of the age 30 years to discuss thin bones, but osteoporosis is best prevented rather than being allowed to evolve. Reductions in bone density have been considered to be more of a female than male health problem, but osteoporosis (and osteoarthritis) is quite common in males over the age of 40 years, even though it may be asymptomatic.
Osteoarthritis, which is the common form of “wear and tear” arthritis, can occur commonly following injury to joint structures and adjacent bones. Osteoporosis (thin bones) and osteoarthritis (creaky joints) go hand in hand. Exercising in the presence of thin bones and creaky joints tends to provide an ideal circumstance for the occurrence of significant sport injuries and if left unattended, it may result in accelerated declines in bone and joint function.
Focus on Nutrition
A well balanced diet can promote skeletal health, provided that animal protein, saturated fat intake, excessive caffeine and alcohol consumption are avoided. At the root of good bone health is an adequate lifelong, dietary intake of calcium, but this is not the whole story. Modern research has indicated that soy protein contains isoflavones which have the ability to build bones. It is recognized that the inclusion of soy protein in the diet may promote the retention of calcium by the body and it may improve kidney function. In contrast, excessive animal protein in the diet has been clearly linked with excessive loss of calcium in the urine and osteoporosis. Switching toward vegetable protein intake has many advantages, including cardiovascular health
Recent studies among elite, Olympic athletes shows evidence of decreased blood viscosity, enhanced performance, improved muscle function and optimal lean body mass when soy is incorporated into the diet. Any man or woman whom wants to prevent osteoporosis should consider soy isoflavones in their diet. When isoflavones are combined with calcium, they have ideal bone building actions
Some less well informed individuals have criticized soy as optimal nutrition for athletes and their performance on the basis of its quality as a nutritious source of protein and the estrogenic effects of isoflavones. In brief, soy is an ideal protein with a nutritional score equivalent to egg, whey, milk and animal protein. Isoflavones are adaptogens, not simple estrogen. They provide a “balancing” act in the body and can even act as antagonists (acting against) to estrogens in states of estrogen excess. The concept of “anabolic drive” in sports physiology sometimes results in unwanted masculinizing (male type hormone) effects. Farsighted nutritionists are looking at the ability of isoflavones to balance this effect and form an ideal nutritional basis for the athlete. It is frequently forgotten that isoflavones have very versatile effects including antioxidant, anti-cancer and very beneficial cardiovascular effects.
Limitations of Arthritis Medications
The most commonly used medications for the treatment of sports injury and osteoarthritis are pain killers (acetaminophen) non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin. The improvement of pain and limitation of movement in damaged arthritic joints is only relieved temporarily by the use of NSAIDs. Chronic dosing with these agents is often necessary and they all share a potential for causing serious adverse effects, such as ulceration of the stomach and duodenum, bleeding from both the upper and lower portions of the digestive tract, toxic effects on the liver, and the risk of renal impairment, especially in the elderly.
Dietary Supplements
Shark cartilage has been proposed as a remedy of natural origin for sports injury, osteoarthritis and osteoporosis. Its use has major support among many professional athletes. Most evidence of the beneficial effect of cartilage supplements in osteoarthritis, sports injuries, and osteoporosis has resulted from clinical studies in which a certain brand of shark cartilage was used. There are many shark cartilage supplements and these may differ in their origin, mode of manufacture, and quality.. Not all shark cartilage products are 100% pure and only one brand has been assessed consistently and found to be useful in clinical trials in several animal species (cats, dogs, horses) and humans. There are increasing concerns about “borrowed science” in the dietary supplement industry and nowhere has this been more apparent than in the case of shark cartilage.
The recognition that chondroitin sulfate is beneficial for osteoarthritis caused a stampede for the purchase of chondroitin supplements in health-food stores. The fuss about chondroitin has died down as people began to realize that this compound is abundant in shark cartilage supplements; where it is present in a holistic format with calcium, collagen, glucosamine-like compounds and anti-angiogenic proteins (Table 1)
Glucosamine and related compounds are major components of proteoglycans and are vital for the synthesis of glycosaminoglycans. These are compounds that hold water in the supporting structure of cartilage. This makes cartilage “springy” and healthy. Glucosamine is composed of glucose and the amino acid glutamine and it stimulates cells in cartilage (chondrocytes) to produce complex sugars and proteins in cartilage. The stimulatory effect of glucosamine on the production of the supporting structures of cartilage and its protective effects may assist in repairing damage to joint cartilage
Essential fatty acids (EFA) have many health giving functions in the body. Our diets are normally adequate in their content of omega-6 series EFA which are found principally in vegetables and in seeds. Fatty acids of the omega-3 series are often deficient in Western diets. These omega-3, EFA are found in fish oil that is known to exert major health benefits in arthritis and inflammation. Fish oil is taken in an enteric coated format that reduces side effects of bad breath and stomach upset. In this enteric coated format (Fisol, BioTherapies Inc., Fairfield, NJ), absorption is improved and people can comply easily with the difficult task of taking fish oil on a regular basis.
Herbals and botanicals have featured strongly for bone and joint health. Many studies have confirmed the benefit of standardized extracts of the plant Boswellia serrata in the treatment of osteoarthritis and rheumatoid arthritis. Boswellic acids can protect against artificially induced arthritis in animals and their anti-inflammatory actions have been well documented in soft-tissue inflammation in human studies. Bromelain is an enzyme from pineapples that has been shown in many studies to help joint function and accelerate recovery from soft tissue injury. Standardized extracts of ginger root have become popular and good reports exist on the benefits of green lipped mussels and sea cucumber to improve arthritic conditions.
The Ultimate Bone and Joint Supplement
New combinations of bone and joint dietary supplements have appeared that combine many of the natural agents discussed in this short review of bone and joint health. In my opinion, the combination of shark cartilage, boswellia, bromelain, soy isoflavones, extra glucosamine and MSM is particularly valuable in sports injury and rehabilitation of bones and joints. A more complete and ultimate bone and joint supplement involves a combination of many agents that can promote bone and joint health. A list of these agents is given in Table 2 and constitutes a formulation that represents, in my opinion, an ultimate bone and joint health supplement.
Components Treatment
Calcium and phosphorus This is an ideal, balanced bio-
in a 2:1 ratio available mineral supplement for
bone (it prevents osteoporosis).
Collagen, type 2 This is a nutrient with potential for the
development of the immune
tolerance phenomenon (e.g., for
rheumatoid and connective tissue
disease).
Glycosaminoglycans These are anti-inflammatory and
(Glucosamine-like) immunomodulating agents (used to
suppress inflammation and enhance
immune function with T-cell and
natural-killer-cell, modulating activity).
Antiangiogenic proteins Varying molecular weight
antiantiogenic proteins have been
repeatedly found in shark cartilage.
The molecular weight of some of
these proteins is such that they may
cross the intestinal mucosal barrier.
These proteins have the potential for
action in many angiogenesis-
dependent diseases e.g., cancer*,
arthritis, skin disease, proliferative
retinopathy, and Kaposi’s sarcoma.
Chondroitin sulfate, heparan, These substances are regarded as
keratan and dermatan being potentially therapeutic for
sulfates arthritis.
Table 1
Shark cartilage constituents with possible health benefits in several disease states. *
Shark Cartilage Soy Isoflavones
Chondroitin Soy Protein
Collagen Curcumin
Calcium Vitamin D
Phosphorus Vitamin C
MSM Green Lipped Mussel
Boswellia Sea cucumber
Bromelain Boron
Zinc Magnesium
Flax Seed Manganese
Table 2
Natural agents that represent an ideal formulation for bone and joint health in the author’s opinion. This formulation is produced as Cartilade Ultimate Bone and Nutrition Formula by BioTherapies Inc., Fairfield, NJ.
References:
Holt S., Bone and Joint Health Part 1 - The Optimal Diet,
Alternative and Complementary Therapies, 4,2, 101-108, 1998.
Holt S., Bone and Joint Health Part 2 - Dietary Supplements, Alternative and Complementary Therapies, 4,3, 195-205, 1998.
Holt S., Gagliardi, G., Fuerst, M. The Shark Cartilage Alternative
for Bone and Joint Health, Keats Publishing Inc., New Canaan,
CT, 1997.
4. Holt S., Barilla, J.R. The Power of Cartilage, Kensington
Publishers Inc., NY, NY, 1998.
National Objectives for Disease Prevention and Health Promotion
for the Year 2000. Washington, DC: National Osteoporosis
Foundation, 1988.
National Institutes of Health. Optimal calcium intake. National
Institutes of Health 12(4):1-24, 1998.
Holt S., The Soy Revolution, M. Evans Inc., NY, NY, 1998.
Holt S., Soya For Health, Mary Ann Liebert Publishing Inc.,
Larchmont, NY, 1997.
Holt S., Saleeby, G. Gastric mucosal injury induced by anti-inflammatory drugs (NSAIDs). Southern Med. J 84(3):335-360,
1991.