When cartilage breaks down and bone rubs against bone, the pain is excruciating. NOHA speaker, Luke Bucci, PhD, has written Pain Free: The Definitive Guide to Healing Arthritis, Low-Back Pain, and Sports Injuries through Nutrition and Supplements.* In the tape of his NOHA talk and in his book Bucci describes many nutrients and certain natural supplements that can gradually restore the cartilage in our joints.

Unlike other body tissues, cartilage has no blood vessels, nerves, or lymphatics. This puts it at a disadvantage in receiving the basics of life: namely, oxygen, water, and nutrients.

Besides water, there are three principal components of cartilage: collagen, proteoglycans, and particular cells, called chondrocytes.

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. . . the cells inside cartilage (the chondrocytes) have no direct access to either our blood or lymphatic systems. Therefore, they depend for nutrients on gradual seepage from surrounding tissues, such as the sinovial fluid.

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Collagen is the most abundant protein in our bodies and it provides great structural strength everywhere it is found, including in cartilage. "The collagen-making process depends on a steady flow of nutrients, including amino acids (protein), vitamin C, iron, copper, and manganese. If any of these are in short supply, the manufacture of collagen is impaired."

Cells and proteoglycans fill up the extra spaces in cartilage around the structural collagen. "Proteoglycans have the consistency of half-set Jell-O." They attract and hold water and make wonderful cushions for our movements. "Each proteoglycan subunit contains a long, core protein to which are attached hundreds of long chains of specially modified sugars. These are called glycosaminoglycans (GAGs), the most important of which is chondroitin (kon-DROE-it-in) sulfate. . . . GAG synthesis must take place before proteoglycan and collagen synthesis."

As mentioned already, the cells inside cartilage (the chondrocytes) have no direct access to either our blood or lymphatic systems. Therefore, they depend for nutrients on gradual seepage from surrounding tissues, such as the sinovial fluid. The chondrocytes produce enzymes that destroy injured or worn out cartilage. This is a slow process because collagen is tough. The chondrocytes also produce new cartilage, usually slowly. "Even bone remodels faster than cartilage!" Sometimes in degenerative diseases, such as some forms of arthritis, the remodeling function of the chondrocytes seems to be turned off. They are just destroying cartilage. However, Bucci points out that when the proper natural biochemicals are present there is evidence that formation of cartilage can recommence. Specifically, the nutrients for GAG synthesis (or GAGs themselves) need to be present for this production to start.

Glucosamine is the single most important component and precursor for GAGs. . . . [Fortunately, glucosamine] is almost completely absorbed from the gut into the blood stream. Like other nutrients some glucosamine finds its way to synovial fluid and . . . blood vessels [that are near cartilage], where it diffuses into cartilage. There, chondrocytes eagerly take up glucosamine, so manufacture of new GAGs and collagen can begin.

Once inside the chondrocyte, the real fun begins. Glucosamine is what is known as a rate limiting  step. This means that chondrocytes determine whether or not they can make more cartilage by how much glucosamine is around. More glucosamine, more cartilage repair. Less glucosamine, less cartilage repair.

In Europe, a number of studies, using glucosamine sulfate orally, have shown good results both for arthritis and for sports injuries. Sometimes, after two weeks or so, glucosoamine is just as effective as conventional pain-killing drugs at stopping pain and later on it becomes even more effective. Also, the mobility of many glucosamine-receiving patients improves whereas the patients receiving drugs often remain as crippled as ever or get worse. Bucci cites studies showing that the usual large doses of certain pain-killing drugs (including aspirin) over long periods of time can exacerbate arthritic conditions whereas glucosamine supplements, other nutrients, plus excellent conventional physical therapy can reverse arthritis.

Unfortunately, some commercially available glucosamine supplements contain about thirty per cent salt (sodium chloride) as a stabilizer and other formulations are quickly metabolized by the liver so less is available for cartilage. Bucci recommends a particular supplement that contains both glucosamine and chondroitin, although none of the European studies were done with any combination.

In Europe, a number of studies, using glucosamine sulfate orally, have shown good results both for arthritis and for sports injuries. . . .Unfortunately, some commercially available glucosamine supplements contain about thirty per cent salt (sodium chloride) as a stabilizer and other formulations are quickly metabolized by the liver so less is available for cartilage.

Bucci emphasizes "Antioxidants against Arthritis," stating that "the big three" for joints are vitamins C and E plus selenium. Antioxidants can retard the erosion of cartilage. Vitamin C is essential for the formation of collagen; also, it reduces inflammation and enhances the healing of wounds. "At the cellular level vitamin E safeguards cell membranes from oxidation." He warns us to choose natural vitamin E, specifically, "d-alpha-tocopherol or mixed tocopherols."

Selenium is a trace mineral with a specialized function. It activates one of the most important antioxidants in the body: an enzyme called glutathione peroxidase. . . . There’s an apparent link between selenium and arthritis. Investigators have found that osteoarthritis sufferers have low levels of selenium in their blood. Deficiencies might even cause arthritis. Areas of the world with a low selenium content in the soil have a higher rate of osteoarthritis, cancer, and heart disease. . . .

Be careful not to take too much, however. It can be toxic. [The doses that we need are in micrograms.]

Bucci provides detailed information on other nutrients that can help reverse arthritis, such as niacinamide (vitamin B3), vitamin B6, magnesium, manganese, copper, zinc, and boron. He mentions the omega-3 fats from fish and points out that they are precursors of biochemicals (prostaglandins) that reduce inflammation. "If you eat a high-fat diet (not recommended), you have to intake even more omega-3 to get results."

Bucci gives detailed "Nutritional Protocols for Joint Health" and his general statements on diet are excellent:

Our usual diet is a recipe for cartilage disaster, which is exactly what the statistics tell us. . . .

Eating right is simply a matter of getting back to nature. A good rule of thumb is to eat foods that are as close to their natural state as possible. . . . You should be eating a bowl of blueberries, not a blueberry-flavored Pop Tart; a bowl of strawberries, not strawberry shortcake; baked potatoes, not reconstituted mashed potatoes; a real apple, not applesauce; crisp, fresh, raw vegetables, not their canned counterparts; a fish fillet, not fish sticks.

Forget about junk foods or processed foods. Stick with real foods.

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*1995, The Summit Group, Fort Worth, Texas, 248 pages, hard cover, $24.95.