Arthritis is not caused by a lack of glucosamine or chondroitin. And it isn’t treated by them either. If you think they’re helping you, that’s the placebo talking. Can Supplements Help Arthritis and Other Aches and Pains? Debunkery and analysis of supplements and food-like medicines (nutraceuticals), especially glucosamine, chondroitin, and creatine, mostly as they relate to pain SHOW SUMMARY

There are several popular nutritional supplements that people take because they are supposed to be “good for” your muscles and joints and aches and pains. They aren’t considered pain-killers, but people take them for pain. They aren’t anti-inflammatories, per se, but people believe they will reduce inflammation. They aren’t performance-enhancing “drugs”, but athletes and bodybuilders take them like almost like drugs to enhance their performance.

What they all have in common is that they are “food-like” — not a food, not a vitamin, but edible and supposedly good for your body one way or another.

This article mainly reviews: creatine, chondroitin sulfate, glucosamine, whey protein, glutamine, turmeric/curcumin, bromelain, caffeine, and Protandim.

Unicorn horn velvet! “So anabolic it’s illegal in 9 countries.” From a parody by NutraPlanet.com of the hyperbolic claims that are all-too common in the nutraceutical industry [link no longer available].

As nutritional supplementation has been studied and tested more carefully over the years, the results of have been generally very discouraging, particularly for the average healthy person with no particular problem to solve.1 New science is showing that even supplement staples like calcium may have more risks2 and fewer benefits3 than anyone suspected. Americans who use supplements don’t live any longer.4 They have been shown to be healthier by some measures, but likely just because people with healthier lifestyles tend to take supplements.5 And that was the basis for this excellent advice:

Be the kind of person who takes supplements — then skip the supplements. ~ Michael Pollan, Food Rules: An Eater’s Manual

Public service announcement: ironically, for all those health-conscious supplements, contaminated supplements are also now responsible for an enormous 50% rise in supplement-related calls to poison centers from 2005 to 2012.6 A huge and totally unregulated industry selling to legions of credulous people who are knee-jerk cynical about Big Pharma but never question the scruples of supplement sellers. What could possibly go wrong? Poisoning—that’s what.

There is some good news below. But, in this climate of mostly discouraging science, it certainly pays to be skeptical about pretty much anything that sounds too good to be true, even simple vitamin and mineral supplementation. Nutraceuticals are on the fringes of supplementation, and are much more suspect. Here is a summary of the most popular:

supplement & summary effectiveness safety more information Glucosamine. Like chondroitin sulfate, known as being “good for cartilage.” An abundant monosaccharide (amino sugar) and a building block of proteins and fats, especially in cell walls. Made commercially by extracting it from crustacean exoskeletons as a supplement used to treat osteoarthritis (especially hips and knees) via alleged anti-inflammatory and other happy effects on cartilage. low plausibility, no good research news in general,78 and it notably bombed two particularly good new tests in 2010,910 benefits for osteoarthritis possibly real but barely clinically significant, like “taking a car from 40mpg to 42mpg” (Examine.com editor Sol Orwell) probably safe at recommended doses, possible pancreatic damage with more11 Examine.com, Wikipedia, QuackWatch and the book Snake Oil Science (Bausell) Creatine. Marketed as “nature’s muscle builder” and an energy-boosting performance enhancer. A form of stored energy for muscles, primarily used by athletes and bodybuilders. The most legitimate sports supplement. heavily studied, and the only major nutraceutical that probably works as advertised no serious safety concerns Examine.com has an extremely detailed & heavily referenced creatine page Chondroitin sulfate. Known as being “good for cartilage” because it is major component of cartilage, and it has much in common with glucosamine (they are often sold together). Chondroitin sulfate is chemically complex, and it’s almost impossible to know what you’re really getting. heavily studied, but no clear good news,12 and a huge slam from the NEJM in 200613 “well tolerated for up to three years,” but many known rare and minor side effects Wikipedia Whey protein. Mixture of globular proteins isolated from whey, the liquid material created as a by-product of cheese production. Prized by athletes as a protein source to aid in building muscle. Wild speculation that it also has anti-inflammatory properties. no controversy regarding bodybuilding benefits, but almost no data at all about anti-inflammatory effects numerous side effects and safety concerns Glutamine & Arginine. Abundant but non-essential amino acids (protein building blocks), mainly stored in muscle. Depleted in the critically ill, glutamine is used medically to aid tissue repair. Athletes and bodybuilders imagine running low on these substances after harsh workouts and hope “topping them up” will help repair/build muscle. See detailed section below for much more. Both of these amino acids have a mess of barely understood properties which might be relevant to exercise performance and recovery,14 such as anti-inflammatory effect,15 stimulation of growth hormone production,16 or dilating blood vessels.17 nearly unstudied in the context of athletic performance and recovery, some promising scraps of basic science only; conflicting evidence even for medical use with critically ill patients both are generally well tolerated, but have long lists of possible side effects and numerous safety concerns for chronic supplementation: “neurological effects were the most frequently observed” problems with glutamine18, and arginine is “associated with death in certain groups of heart patients”19 no good sources known20 Collagen. Extremely abundant proteinacious building block of connective tissue, currently popular as an arthritis treatment in the form of products like Genacol. Usually used for skin and nails. However, assuming extra collagen is helpful in any way, it is probably impossible to get it by eating it in the form of a supplement.21 extremely limited and poor quality evidence probably safe — it’s just protein, and already a major component of other foods — but unstudied Scott Gavura’s collagen review for ScienceBasedMedicine.org Turmeric/curcumin. Curcumin is the biologically active part of turmeric. Many health benefits claimed, including anti-inflammatory effects. evidence too limited to be even suggestive possibly safe, minor digestive side effects most likely Wikipedia Bromelain. A pineapple enzyme, better known as a meat tenderizer, that may also have anti-inflammatory properties. limited but somewhat promising possibly safe, minor digestive side effects most likely eCAM Protandim. Patented “blend of phytonutrients” from a multi-level marketing company, with slick marketing emphasizing anti-aging effects … which should set off every caveat emptor alarm you’ve got. The product allegedly treats pain and inflammation via antioxidant effects and “activating” the Nrf2 protein. a handful of test-tube and animal studies, no human studies related to pain at all, only two (irrelevant and negative) human studies mostly unstudied, unknown a good overview on ScienceBasedMedicine.org,2223 Wikipedia

Examine.com emerged in 2012 as a great new source of information about supplements & nutraceuticals, with a much more ambitious scope than this page. Check ‘em out. They are still going strong in 2020, better than ever.

Do nutraceuticals show promise in general?

No, they do not. Many of the supplements above make little or no sense even in principle: regardless of whether or not we need a substance, it is often impossible to get more simply by eating it.24 And nearly all of them have been failing a basic credibility test for years: a lack of good evidence of efficacy, and not for lack of trying in the case of the popular ones. Only one of them (creatine) is a clear winner. Not one other is definitely helpful.

If any of the others truly had significant therapeutic effects, it shouldn’t be hard to prove it, should it? There should be studies that don’t just “kinda” show some benefit … maybe … . There should be studies that leave no doubt there is something there.

There’s a lot of seemingly conflicting evidence about nutraceuticals. However, there’s a pattern of much ado about nothing. Even the most generous interpretations of the most positive-seeming results are still kind of underwhelming. Generally speaking, nutraceuticals fail the “impress me” test.

And that squares nicely with the anecdotal evidence, which is hardly impressive either, despite great commercial success and lots of enthusiasm.25

Instead mostly we just have a mess of weak, confusing evidence, and it probably won’t get any better. It’s rare for anything particularly good to finally emerge from that kind of mess. The history of medicine shows us clearly that most popular remedies lacking good scientific support usually turn out to be popular because they are popular (and aggressively marketed) — not because they ever actually worked.

I am not optimistic about nutraceuticals in general. I am particularly pessimistic about the ones that are supposedly anti-inflammatory.

Anti-inflammatory nutrition vs. supplements

Many supplements are touted to be “anti-inflammatory,” but loose usage has rendered this concept almost as meaningless as “detoxitication. Inflammation is the action of the immune system, and immunology is the ultimate in physiological complexity. Inflammation is not one thing, but an enormous family of overlapping and interacting processes, many of which are essential to life. In general, it’s not that we want less inflammation in our lives — it’s that we want a dynamical and dazzlingly complex balance of just the right types of inflammation in the right places, times, and amounts… all of which is a constantly moving target, as it strong interacts with things like your gut microbiome.

Based on the complexity alone, you can see that anti-inflammatory claims are broadly implausible. Any one substance is less likely to “fix” an inflammation problem than any one wrench is going to fix a broken down car.

There’s a lot of overlap between the idea of anti-inflammatory supplements and an anti-inflammatory diet. I think most people imagine that a inflammatory diet contains special foods — “super” foods, even — that have anti-inflammatory properties. And to whatever degree you accept that, then why not just eat whatever makes those foods special? Why bother with the food?

Because there mostly is no such thing as special anti-inflammatory ingredients — either as part of food, or isolated as a nutritional supplement. An anti-inflammatory diet is just a diet that avoids foods that are inflammatory… which is mostly just junk food. So what’s an anti-inflammatory diet? Just a diet that isn’t terrible.

A few foods do seem to have some anti-inflammatory properties, but it’s quite rare, and they seem to be hard to extract and isolate. The main example of this is fish…

Fish oil and exercise recovery

Fish is a really healthy food. And it is also, in some ways, actually anti-inflammatory. For instance, it has shown some potential to aid with recovery from exercise.26 The evidence is not compelling, but it’s noteworthy (especially the apparent effect on strength and ROM recovery).

However, extracting and isolating what we presume to be the active ingredient — omega-3 fatty acids — has mostly not been working out very well. That is, fish is better for you than fish oil supplements. So even to the extent that some nutrients truly are anti-inflammatory… they are much more effective when consumed as part of food, not as a nutritional supplement.

This is probably a general principle.

You: This one untested supplement will restore balance to my body



Your body: pic.twitter.com/pJjvk3E44v — Peter🌋📈⛰️🌧️📉Brannen (@PeterBrannen1) January 9, 2020

Glucosamine — leading by example?

Glucosamine is the best-selling of all nutraceuticals, and so you’d hope it was also the best — if any of them work, it should be this one. But glucosamine has never been particularly plausible as a medicine,27 and it’s been slammed by the research evidence so far. The bad news really piled up in 2010 with two F-grades on large, fair tests — one for low back pain and another for knee pain (referenced above in the chart) — and another flunk from a huge 2010 meta-analysis of 3800 patients.28 A major 2015 report on knee osteoarthritis treatments declared it to be particularly useless (along with chondroitin sulfate).29

If glucosamine were a student, its parents would get called in for a conference about little glucosamine’s poor performance. Perhaps there’s something going on at home? Here’s the conclusion on the report card for knee pain for both glucosamine and chondroitin sulphate, from Sawitzke et al:30

Over 2 years, no treatment achieved a clinically important difference in pain or function as compared with placebo.

The pile of glucosamine failures is now getting rather tall. In July 2010, Dr. Harriet Hall reviewed the evidence of absence of any glucosamine benefits at ScienceBasedMedicine.org and concluded that glucosamine proponents

… can always complain that maybe it works for knees but not for hips, or that a different dosage might have worked better, or that it works for some small sub-set of patients. There will always be “one more study” to do. … This new study confirms my opinion that we shouldn’t spend any more research dollars doing “one more study” on glucosamine.

Not that this evidence will actually stop people from “believing” in glucosamine and buying it in bulk! Glucosamine bottlers will really appreciate everyone’s continued gullibility.

Ergo-what? The overlap between ergogenic aids, nutraceuticals, and energy drinks

Ergogenic aids are quite literally anything — any external influence on the body — that can (in theory) improve physical or mental performance, or recovery from fatigue and injury. These include devices, drugs, nutrition and even morale boosters. It’s a broad category!

Ordinary food itself does not “boost performance,” except in the obvious way: we need fuel! But vitamins and supplements are definitely not needed for performance if you are getting enough energy from a reasonably varied diet. Products that offer benefits beyond this are “ergogenic aids” and are poorly regulated and should be used with caution … and that’s the official position of various organizations of experts.31

People gobble them up anyway, of course.

The most familiar of the ergogenic aids are the energy drinks, like Red Bull, Full Throttle, or Rockstar. Virtually every imaginable ergogenic aid has been put into drink form for you. Pharmacist and writer Scott Gavura cuts energy drinks down to size in a recent analysis:

Despite the impressive lists of ingredients and slick marketing, these products are essentially caffeine delivery vehicles, most of which come loaded with sugar.

Ergogenic aids as medicine

Many people use ergogenic aids because they believe — and maybe it’s a reasonable leap of logic — that anything that enhances performance is also a kind of medicine. Perhaps a body that feels stiff, painful and weak needs “performance enhancement” as much as an athlete? Or more? Adaptation to exercise and healing from injury may just be two ends of the same spectrum — different extremes of the same fundamental process. To recover from exercise is like minor healing. Maybe.

While that might work in some cases, it doesn’t necessarily follow. It’s equally clear that enhanced performance can come at a cost. Performance-enhancing (anabolic) steroids are obviously an ergogenic aid, but also have such serious side effects that no one thinks of those as “medicine.” Or consider caffeine, discussed more below: it is widely used as an ergogenic aid, and yet it also makes sense that it could actually increase vulnerability to pain, even if only by interfering with sleep.

I think it’s a crucial (and interesting) part of the psychology of this kind of supplementation. Whether it makes sense or not, the performance-enhancer = medicine idea may actually be the reason why a lot of people are taking something like creatine for pain problems … even though it’s known primarily as an ergogenic aid, and not a pain medication. Let’s get into that a little deeper …

Creatine and pain: is there a connection?

First, let’s just establish that creatine probably actually works as it is mainly advertised, and it might be the only major one that does. Once upon a time, I was too hard on creatine. It was a victim of my cynicism about the industry. I didn’t take it seriously, didn’t look at it closely enough, and tarred it with the same brush as other much less useful products. I’m pleased that the lads at Examine.com eventually turned me around on this topic. They used evidence on me, and it worked.

So, creatine, I’m sorry I misjudged you. You seem like a stand-up nutraceutical!

I’ve looked for negative and skeptical evidence and opinions on creatine. The negative opinions aren’t hard to find, but they are all of the same species that mine was: entirely reasonable general cynicism about supplements. And yet the cynicism doesn’t seem to be justified in this particular case, because actual negative evidence is awfully scarce, and there is plenty of pretty clearly positive evidence. For instance, if you read QuackWatch’s creatine page, it’s remarkably nice. Although “not recommended for the average athlete,” that’s based mostly on a lack of safety evidence (which has emerged since).

It’s important to acknowledge that some people do not respond to creatine. However, that is not surprising: there are non-responders to every drug, even the most effective drugs ever developed.

Creatine is straightforward: claims made for it are not extraordinary, it seems to work, and there is now plenty of evidence showing that it’s very likely to be safe as well. Examine.com’s mighty creatine page is, as far as I can tell, pretty much spot on. I think it’s well done, extremely thorough, and balanced. If you want the creatine science, go there (“453 unique references”).

I honestly see no reason why somebody shouldn’t supplement creatine, nor do I see any logical basis for the seeming ‘fear’ of this compound in society. Its safe, it healthy, its cheap, and for most people it just works. Get some Creatine Monohydrate, take 5g a day, and you’re good to go. If humans didn’t make any in the body, this thing would be a vitamin. There do exist deficiency symptoms that result in mental retardation. They’re rare, but they pretty much establish the importance of this molecule as a vitamin-like compound. Kurtis Frank, The “Editors' Thoughts on Creatine” on examine.com

(The only fly in the creatine ointment that I know of is that it gives some people trouble with sleep, and that happened to me. See my insomnia article for the story. But I think this probably isn’t a major issue for many people.)

The pain connection

Writing about nutraceuticals isn’t exactly on my bucket list. I’m keen on them to the extent they might help with pain. The connection is obvious with glucosamine (supposedly an arthritis fighter), but there is no clear connection between creatine supplementation and pain. So what am I going on about it for?

The following is pure speculation and may be ridiculous. Truth not guaranteed. Chance of wishful thinking: 60–70%.

So creatine’s main benefit is muscle fatigue resistance. Muscle cells take longer to tire out when they have extra creatine in their little cellular pantries. It’s an energy intermediate that helps replenish the fuel molecule, adenosine triphosphate (ATP is one of greatest hits of organic chemistry). Bobybuilders take creatine so they can lift longer. It’s firmly in the category of an athletic performance enhancer, and not a “treatment” for anything … except fatigue at the end of a set. Could this be relevant to certain kinds of pain? Perhaps.

I don’t know about you, but I often have a hard time telling the difference between pain and fatigue. That’s not entirely a coincidence of course.

Exercise recovery, performance enhancement, and treatments are different aspects of the same thing. People “recover” from both exercise and injury. An increase in function is called an effective “treatment” if you start out in a bad place, but it’s a “performance enhancer” if you were healthy to begin with. There are so many overlapping factors in what constitutes function and dysfunction that it is generally plausible that anything that is known to increase performance in healthy athletes may also “increase performance” — treat — unhealthy people in pain. It all depends on the specifics, of course. In this case, muscle pain and fatigue might be related.

Muscle is a likely factor in many common body pains. The exact mechanism of this is unknown, but muscle fatigue seems to be a risk factor for episodes of muscle pain — and not just the soreness that always follows an ordinary workout. “Fatigue” is a complex state, a spectrum of biological circumstances, not just energy depletion in muscles during exercise. That biology probably overlaps to some degree with body pain. Most people with acute muscle pain also report feelings of weakness and fatigue. By no means do those sensations necessarily mean that more fuel in muscle cells would help … but it’s not out of the question.

And it’s not expensive.

And it’s at least as safe as eating Twinkies. Quite likely safer.

And it will, if nothing else, probably increased your resistance to fatigue at the gym.

And maybe it will help with some chronic body pains. I think it’s a rational thing to try, at least, because the biology of muscle fatigue might have enough in common with the biology of aching.

Bromelain, a lesser known anti-inflammatory nutraceutical that might be more evidence-based

Bromelain is worthy of a closer look. It is one of two pineapple enzymes, plus a few other compounds. It’s best known as a meat tenderizer, but may have anti-inflammatory properties as well. Somewhat less of a “nutra” and more of a “ceutical”, bromelain could possibly have the potential to be used in place of anti-inflammatory drugs.

What jumps out at me about bromelain is that the evidence looks a little better than for some of the other popular nutraceuticals. Some half-decent research has been done on it, although nowhere near enough to actually come to anything like a conclusion.

In 2004, Brien et al reviewed one dozen studies of bromelain research in Evidence-based Complementary & Alternative Medicine .32 Despite a blatant conflict of interest — Brien works for a bromelain manufacturer — the review seems balanced,33 and the authors do not fail to point out weaknesses in the evidence or concerns about adverse effects. Their conclusion is cautiously positive, and it does seem to be justified by the evidence reviewed: in this study bromelain certainly seemed to do something to help people with painful osteoarthritis.

“The currently available data do indicate the potential of bromelain in treating osteoarthritis.”

However — and this is really important perspective — we already have medications that “do something” to help people with painful osteoarthritis. To really qualify as a replacement for existing medications, bromelain (or any other nutraceutical) would not only have to work just as well, but also have fewer side effects. “Effective but safer alternative treatments would be of benefit to osteoarthritis sufferers,” write Brien et al.

This has not even remotely been established yet. Until it is, bromelain is nothing more than a possibly effective nutraceutical that might or might not have fewer side effects. Remember that side effects can be rare and widely variable, so even if many people have no problems, lots of others might — you can’t say that bromelain has no side effects just because you got away with taking it!

Caffeine improves physical and cognitive performance during exhaustive exercise, but also carries a risk of actually increasing pain

Caffeine is widely believed to be an ergogenic aid … and, for once, the evidence supports popular belief. It doesn’t even matter how much of it you drink normally: you’ll get a boost from it whether you guzzle the stuff every day, or never touch it.34

I’ve played a lot of ultimate with players who are younger, fitter, and more talented. I’m just happy that I can play on the same field and not embarrass myself … much. Without a doubt, the most limiting factor is exhaustion: I often make tactical mistakes or throw “swill” (ultimate slang for a lousy throw) not because I don’t know how to play the game, but because I’m just too whipped to play it well. The older I get, the more it happens.

Caffeine to the rescue!

According to Medicine & Science in Sports & Exercise , caffeine really will “significantly improve” not only endurance performance, but “complex cognitive ability during and after exercise.”35 Sign me up! I’ve already pretty much embraced caffeine as one of those rare pleasures in life that has minimal downside — this is just gravy!

The researchers studied 24 well-trained cyclists, giving them either 100mg of caffeine or a placebo and then testing their endurance and their mental function during and after workouts. The signal was loud and clear: caffeine consumption boosted their performance. I can hardly wait to eat some caffeine before my next game!

But there are also problems: caffeine makes us hyper, and is probably somewhat exhausting. We pump more adrenalin, exhaust ourselves, lose sleep: risk factors for pain. Chronic, excessive caffeine abuse — vicious cycle of self-medication, caffeine every morning, alcohol every night, very common — could well be an aggravating factor in cases of chronic pain. So here we have a substance that is, on the one hand, almost certainly an effective ergogenic aid, and even a short-term reliever of pain, but probably also a long-term aggravator of pain when chronically abused.36

Bottom line: caffeine is a known mild analgesic and ergogenic aid, but caffeine abuse — which is super common — is a plausible risk factor for chronic pain.

If you’re going to drink it (and you probably are) what’s the best source of caffeine? Scott Gavura reports that “coffee has more caffeine than many energy drinks. A 16 oz ‘grande’ coffee at Starbucks has 320mg of caffeine … in comparison, a Red Bull has 151mg/16 oz.”

So go ahead and enjoy your Red Bull. But when that liquid candy stops appealing to you, I’ve got some shade-grown, bird-friendly, passive-organic, fair-trade, home-roasted coffee for you to try.

(P.S. It also doesn’t dehydrate you. That’s a silly myth.37)

Glutamine and arginine for exercise recovery and soreness? Faith-based supplementation based on the extreme (and controversial) example of critically ill patients

I have always really paid for my workouts. I get DOMS (delayed onset muscle soreness) something awful, and always have — some unsolved mystery about my biochemistry. It starts soon after a run or a game of ultimate, and last 2-3 days. The only thing that helps is being as fit as possible at all times: if I take a break, it will be nasty when I get back to it. After griping to my (excellent) doctor about this recently, he recommended that I try arginine supplementation. Why?

Amino acids and healing

Both glutamine and arginine are abundant non-essential amino acids (protein building blocks). Both are needed for tissue repair, which is the basic reason for thinking they might help with exercise recovery. There is not much reason to emphasize arginine over glutamine, since the rationale for using both is pretty similar — and similarly weak, as their clinical effects are generally complicated and under-studied.

Glutamine is the most abundant non-essential amino acid in the body, much of it stored in muscle. Both glutamine and arginine can become depleted in people recovering from major injury and illness, in which case they are regarded as “conditionally essential” — that is, essential during emergencies, when there’s a great deal of tissue rebuilding going on. For this reason, glutamine especially is used medically to treat the critically ill, but the value of this is still scientifically controversial. Arginine is used less, mostly because of safety concerns.

Extrapolating from that extreme (and sort-of medically endorsed) usage, athletes and bodybuilders take a lot of the stuff because they believe that their exertions may be so harsh that they run low on amino acids in the aftermath, and they hope that topping them up will help them repair and build muscle. However, it is unlikely and generally implausible that healthy athletes are ever glutamine depleted in the first place,38 and therefore it is also a bit unlikely that they can benefit from supplementation for this reason.

There are other possible reasons. Both of these amino acids, and a few others, generally have a mess of barely understood properties which might be relevant to exercise performance and recovery, such as stimulation of growth hormone production, or dilating blood vessels. Guessing about how this stuff works out in the real world is basically gambling with your biochemistry, though.

The state of the research for arginine and glutamine supplementation is, predictably, rather poor. Their use appear to be faith-based, not evidence-based.

I spent about a half hour poking around for glutamine/arginine science on the web and PubMed, and determined only that they are nearly unstudied in the context of athletic performance. 99% of search results are places to buy the stuff, with another .9% being blog posts enthusiastically recommending it because “research has shown” that it works (almost always not mentioning what research). I was unable to find any thorough critical analysis of either (although MayoClinic.com has dry but thorough evidence summaries for both). I found one good-news study, but it’s weak sauce.39

There’s some encouraging scraps of basic science about both amino acids, but even their medical usage — glutamine for critically ill patients — remains controversial because the evidence is incomplete and conflicting. So there’s really no hope that we will know any time soon what, if anything, either of these substancs do for something as trivial as a little bit of exercises muscle soreness after exercise.

Meanwhile, there are safety concerns for chronic supplementation of either. For glutamine “neurological effects were the most frequently observed,” and arginine is “associated with death in certain groups of heart patients.”

Tart cherry juice

There’s just enough good news about black cherry juice to include it here. Just barely.

Recovery from intense exercise can probably can be at least partially enhanced with, of all things, tart cherry juice. It’s the antioxidants, see. (That word makes me a little suspicious.) Cherry juice, it seems, is chock-a-block with them and other “anti-inflammatory agents.” None of these things have proven to be especially helpful for muscle soreness before. But the cherry cocktail is special, because apparently if you give cherry juice to several young men and then make them exercise their biceps viciously, they experience a statistically significant 22% less strength loss40 than their poor peers who got fake cherry juice: black cherry Kool-Aid.41

That’s the good news: black cherry juice made a modest but clear and worthwhile difference for those guys in that test. The bad news? It had no effect whatsoever on the symptom everyone actually cares about: the pain. “Relaxed elbow angle and muscle tenderness were not different between trials.”

I was going to run to the store to buy some cherry juice when I read that. Now I think I’ll just walk.

Vitamin D

Vitamin D deficiency is probably more common than once suspected — at least 1 in 20 people in the lowest estimates,42 and possibly many more.43 It can also cause subtle widespread pain that may be misdiagnosed as fibromyalgia and/or chronic fatigue syndrome, including symptoms like muscle and bone aching,44 fatigue and weakness, lower pain threshold, and more acute soreness after exercise that is slower to resolve.

I’ve covered this important topic in much greater detail in a separate article: Vitamin D for Pain.

If there’s only one supplement you’re taking for your health and your diet is decent, it should probably be Vitamin D. Herman Gill, Examine.com editor (Vitamin D reference page)

But it worked for me!

Good! But please curb your enthusiasm: even if something really did “work for you,” that doesn’t mean it’s working for anyone else. To be considered safe and effective, a medicine or treatment has to have a solid cost-benefit profile for most people, most of the time. There are lots of treatments that are good for a handful of people, once in a blue moon. If you are one of those lucky ones, please don’t assume it means that the product is the best thing since sliced bread.

It’s more likely that you healed all by yourself, however.

It’s pretty unlikely that any nutraceuticals should get the credit for healing. It was probably all you: lucky natural healing, and maybe some of your mind powers! Placebo, in other words. Placebo is a powerful, extensively studied, and very real and interesting phenomenon. See The Strange Powers of the Placebo Effect 2:57 for a terrific 3-minute video tour of the “the many strange effects of placebos.”

These products aren’t proven. Placebo is.

Sometimes you can get a nice synergy between natural healing and placebo which really makes an impression. That is: if your tissues are already just starting to recover naturally (perhaps too little to have even noticed, or not enough to get excited about), and then you add a good placebo effect, recovery can be striking and rapid. Since desperate patients are nearly always using some treatment or another at the time that this happens, it usually gets the credit — but obviously it shouldn't. This kind of confusion about the real cause of recovery is the norm, not the exception.

Nowhere in health care do testimonials and anecdotes seem to play a bigger role than they do here: with things you put in your mouth. Unfortunately, they are pretty much worthless.

The Multi-Level Marketing Connection

Many nutraceuticals and supplements are sold using “multi-level marketing” ( MLM ), in which products are mostly sold internally to recruited distributors, and the real money is made by getting kickbacks from all your recruits and their recruits. I have direct personal experience with MLMs, having been sucked in by one of them for almost a year in the early 1990s — a very embarrassing chapter of my life, but full of valuable lessons. I know from that experience all too well that MLMS success depends on becoming an intense proselytizer: you have to not only sell the product, but sell the idea of that the product is so great that your customer should become a distributor.

The whole thing is powered by hype and dreams of getting rich quick.

That’s all kind of gag inducing, but MLMs are actually fundamentally fraudulent. Many people are under the false impression that some MLM schemes are “not really a pyramid” or otherwise okay, but even the best of them are still dubious, distasteful, and harder to make money with than it seems at first. They are technically legal, but they shouldn’t be. As with supplements themselves, legality is a poor guideline — many scams are legal!

It says something about supplements that they are so routinely sold by such scammy methods. Probably every imaginable product has been sold via MLMs, but supplements and snake oils are that industry’s favourite product category by far.

Alternative medicine practitioners are juicy targets for MLM recruiters. Because of their, er, “accepting nature,” they are easily recruited, and simultaneously become victims to a scam themselves … and then start passing it on to their patients. For instance, it’s extremely common for chiropractors and naturopaths to sell nutraceuticals and supplements in their offices, and they are often distributing for an MLM as well as retailing. In my career in massage therapy I encountered many colleagues who attempted to recruit me into an MLM, usually to sell supplements.

MLMs practically constitute a subculture of alternative medicine. Make of that what you will.

Information is Beautiful

Here’s a great way to conclude this tour of nutraceuticals: in 2009 InformationIsBeautiful.net published a brilliant, beautiful and interactive visualization of the popularity and effectiveness of popular dietary supplements. It’s a very good graph, but notice that it neglects a crucial factor: risk. No biological benefit of anything you put into your body can ever be meaningful without contrasting it with the possible dangers of doing so, and unfortunately that consideration is routinely overshadowed by discussion — and lovely diagramming — of the possible benefits. Nevertheless, pretty interesting (and pretty) diagram:

Rather a lot of products are below the “worth it” line! There are also many above the “worth it” line, but please notice that very few of those have anything to do with body pain — only one in fact, devil's claw.

About Paul Ingraham I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.

Related Reading

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Anxiety & Chronic Pain — A self-help guide for people who worry and hurt This article covers prebiotics and turmeric/curcumin, which both show some potential as a treatment for anxiety.

Does Epsom Salt Work? — The science and mythology of Epsom salt bathing for recovery from muscle pain, soreness, or injury. Many people use Epsom salt for essentially the same reasons they would supplement magnesium.

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