Do Liquid Supplements Relieve Joint Pain?
Oral, Natural, Non-Animal Hyaluronian Supplements Work
Several companies have commercialized liquid supplements for health care. Some of these products contain less active ingredients than their capsule or tablet competitors and may appear to be more expensive. An obvious question to address is: Are these liquids truly effective if they provide a lower amount of active ingredient per dose/serving? Hyaluronan is often injected into the knee joint of patients but can an oral, liquid or solid, hyaluronan supplement provide relief to patients?
Oral ingestion is the most convenient and commonly used route of supplement delivery due to its ease of administration and cost effectiveness. The major challenge with the development of oral products lies with the poor bioavailability of many natural active ingredients. The oral bioavailability depends on several factors including aqueous solubility, dissolution rate, permeability and other parameters associated with the biological process of gastrointestinal absorption. One of the most frequent causes of low oral bioavailability is due to poor solubility.
Any supplement active ingredient, or drug, to be absorbed must be present in the form of an aqueous solution at the site of absorption in the gastrointestinal tract. The active ingredient is not ready for absorption when you ingest a solid product formulation, such as a capsule or tablet. The first step in the absorption process is the disintegration of the solid dosage form (capsule or tablet) followed by the solubilisation of the active ingredient. If the active ingredient cannot be solubilised, it cannot be absorbed by the gastrointestinal tract. This is a well established biological principle.
The percent effectiveness of the disintegration-solubilisation process impacts the amount of active ingredient absorbed per serving. Unfortunately, the amount solubilised does not equal the amount absorbed. The percent absorbed by the body is dependent on the above process and the mode of absorption of the specific active ingredient. Some ingredients have poor bioavailability and product formulators try to improve the absorption by using novel excipients. But with some ingredients, despite good solubilisation, the body simply cannot absorb greater amounts. This justifies questioning if hyaluronan is absorbed.
In simple terms, the efficiency of the absorption process is significantly greater for a liquid (solubilised) oral supplement simply because the human body does not need to first disintegrate the capsule-tablet and then solubilise the ingredients. Many people take proton pump inhibitors (PPI) to reduce stomach acid. The ‘reduction’ of stomach acid decreases the disintegration-solubilisation of some supplements (because acid is required for this process). For these patients, liquid supplements are a better choice because the ingredients are already in a solubilised form ready for absorption.
Natural hyaluronan (hyaluronic) (HA) supplements are made from fermentation (produced by yeast or bacteria) or are extracted from animal (bovine, poultry, pig) skin or comb (poultry). The fermentation type of manufacturing is a common method used today to fabricate many natural or complex ingredients. HA is a polysaccharide which is found widely in the extracellular matrix of connective tissue, such as synovial (joint) fluid, cartilage, skin tissue and some other tissues. HA is an important component of joint cartilage (coats the chondrocyte cells). It is a lubricant giving the joint the capacity to resist compression. The amount of HA begins decreasing when the body ages reaching its lower levels by the age of 60 to 75 years. With lower amounts due to aging or disease, the joint loses its ‘lubrication’ and pain and inflammation sets in. Significantly lower levels (or smaller polymer sizes), are found in the synovial fluid of worn versus healthy knees.
HA products have been around for a relatively long time but these were mainly in the form of injectables. By injection, doctors can deliver the HA directly to the areas where it is needed: directly into the knee or under the skin to reduce signs of aging (e.g., wrinkles). Several clinical trials demonstrated that intrajoint HA injections are highly effective in the treatment of osteoarthritis.
Will the body absorb an oral formulation of HA considering the type and size of the ingredient? If absorbed, will the HA reach the joint or skin? A detailed review of the scientific and medical studies reveals that high molecular weight HA is absorbed when given orally. Studies demonstrated that HA with molecular weights between 1 and 1.5 daltons were absorbed. A liquid HA supplement made from a fermentation process (non-animal) has a range of molecular weights between 1.2 and 1.5 daltons; similar to the molecular weights used in the studies. This research also demonstrated that HA is distributed to the joint and skin tissues after oral ingestion and that the HA remained present in the joint tissues even 48 hours after administration.
The body of evidence shows that an oral HA supplement can be effective for joint pain because the HA is delivered to the joint tissue. A placebo-controlled clinical trial demonstrated that oral HA enhanced several markers of quality of life, such as pain and physical functioning, in adults with osteoarthritis of the knee thereby collaborating the evidence demonstrating its oral delivery to joint tissues.
Bottom line, although some liquid oral supplements may cost more, they provide a solubilised form of the active ingredients giving these products superior absorption. Because of the superior absorption, you do not need to ingest as much as the solid form (capsule, tablet) so it is only normal that these liquid supplements recommend a lower daily amount of the active ingredient for ingestion compared to the solid products. Oral HA supplements are a good alternative health product for the care of joint inflammation and pain. They can be used in combination with many other joint care products.
As with all supplements, consult your pharmacist about any potential drug-HA interactions prior to taking any supplement. Also let your healthcare professional know what products you are taking so that they can adequately monitor your health condition and any potential risks associated with the remedies. If you are taking PPIs, like Nexium or Zantac, talk to your pharmacist to be sure that the reduced acid won’t interfere with the absorption of the active ingredients.