Bone broths are highly valued for their benefits, especially for joints and the digestive tract. Name almost any major cuisine in the world and broths and stocks are essential components. In pre-late 20th Century households, these liquids provided the foundation for sauces, soups, stews and numerous other products of the kitchen. However, they went beyond this to provide the bases for nutrient rich tonic foods considered to be good for the bones, joints, digestive system, immune system and general vigor.

The traditional expectations of bone broths are given in numerous books and articles on the topic, but are unlikely to find substantiation as such on PubMed because modern medical research focuses on pure compounds and on items that can be patented. Bone broth benefits from the broths themselves generally are observations from history, not from the scientific literature. For those who are interested, a full history of gelatins and similar usage and science focusing on knowledge and use up to the end of the 19th Century can be found in Gotthoffer, NR, Gelatin in Nutrition and Medicine(Graylake IL, Grayslake Gelatin Company, 1945), which can be purchased as a Kindle edition on amazon. Another book on the topic worth reading is Nourishing Broth: An Old-Fashioned Remedy for the Modern World by Sally Fallon Morell and Kaayla T. Daniel. More history, but also modern science focusing on individual broth components is wonderfully reviewed in "Traditional Bone Broth in Modern Health and Disease," by Allison Siebecker in the Townsend Letter for Doctors and Patients (2005).¹

The benefits of traditional bone broth reflect an emphasis on the building blocks for tissues as the sources of repair. The idea is not to substitute for the body’s own mechanisms, but instead to assist the body in making its repairs. In line with this approach, collagen and gelatin components, such as chondroitin sulfate, found in bone broth support the tissues in the body that themselves are constructed or repaired from these components, for example, the joints and their cartilage, the skin, and connective tissues in general. Similarly, minerals from bone broth support or even stimulate the repair of various tissues. Keep in mind that bone broths traditionally were foods, which are to say, consumed in considerable quantity in gram amounts, not milligram amounts. Efficacy in milligrams only is important for tablets and capsules and often focuses only on the narrowest of ranges of benefits. Total Health has touched on this issue before in terms of the entourage effect (September 2015). This issue has been examined in medical circles, for instance, "Whole Food versus Supplement: Comparing the Clinical Evidence of Tomato Intake and Lycopene Supplementation on Cardiovascular Risk Factors."²

Bone Broth Nutrition Basics
Before examining one bone broth component–chondroitin sulfate–in depth, below is a short listing of the a few of the nutrients found in bone broths.

Amino Acids
Bone broths throughout history have been associated with healing, whether of the gut, the joints, or more generally in response to illness. Part of the reason for this involves immune-supporting amino acids. Depending on the broth, these include arginine, cysteine, glycine and proline. These are found in beef and chicken bones, marrow, etc. Fish broths offer different nutrient mixtures from those found in land-based animal broths. For those interested in the roles of proline and glycine in digestive health, the Weston Price Foundation has published "Why Broth is Beautiful/Essential Roles for Proline, Glycine and Gelatin."³

Collagen and Chondroitin
More specific nutrition factors include bioactive Type I and Type II collagen peptides and cartilage chondroitin sulfate. Collagen is the most abundant protein in humans, representing about 25-30 percent of total protein in the body. It is the main component of skin, cartilage, ligaments, tendons and bones. Glucosamine, chondroitin sulfate and hyaluronic acid (a component of Collagen Type II) are the chief components of the extracellular matrix.

Collagen Type I is associated with the preservation of bone mineral density; in conjunction with hydroxyapatite, it accelerates osteogenesis. There is a further association with the health of the immune system known as oral tolerance that may be important for joint health.

Collagen Type II is a low molecular weight, water-soluble glycosaminoglycan complex that supports joint health and skin hydration.

Chondroitin Sulfate acts like a biological version of a "liquid magnet," attracting fluid into proteoglycans, protein chains that form the basis of cartilage and the extracellular matrix. This fluid acts as a shock absorber and also brings nutrients with it into the cartilage. Perhaps of greater significance than its fluid-enhancing properties, chondroitin protects existing cartilage through its modulatory effects on enzymes that degrade cartilage. Furthermore, chondroitin stimulates the production of proteoglycans and collagen that are needed for healthy new cartilage.

Natural Cartilage Components Heal The Joints
A just released study in the Annals of the Rheumatic Diseases (May 2017) shows that a relatively small quantity of the supplement chondroitin sulfate is effective in improving the symptoms of osteoarthritis.⁴ Pitted against either the prescription drug celecoxib (Celebrex) or placebo in a blinded trial, 800 mg chondroitin sulfate per day led to improvements in pain and joint function that were significantly greater after six months (chondroitin sulfate) and three months (celecoxib). Joint function improved more quickly in patients taking celecoxib, but there were no overall differences in the effectiveness and the benefit-risk profile strongly favored the chondroitin sulfate treatment. These results should be viewed in light of a 2016 study that demonstrated in a 2-year randomized controlled trial that treatment with 1,200 mg per day chondroitin sulfate was superior to celecoxib in preventing cartilage volume loss.⁵

Such results offer the promise of help to large numbers of individuals. Joint pain and connective tissue injuries are amongst the most common complaints of older individuals and affect 15 percent or more Americans whom exhibit some form of arthritis. Not just the elderly, but even young and fit athletes through overuse can exceed the repair capacity of the joints. Non-steroidal anti-inflammatories (NSAIDS) can relieve pain and initially help with joint inflammation and swelling, yet at the cost of slowing healing and for some individuals causing irritation and bleeding of the stomach. This has led to a search for alternatives. The idea that natural compounds such as glucosamine and/or chondroitin sulfate might have therapeutic effects in treating osteoarthritis by providing the substrates for the repair of cartilage has been around since the mid-1950s. Major issues have included determining which forms and how much of such supplements are necessary for benefits. For instance, confirming earlier studies, research published in 2005 involving approximately 1,500 osteoarthritis patients demonstrated that a daily dose of 1,500 mg glucosamine hydrochloride in combination with 1,200 mg chondroitin sulfate was equally as effective with fewer side effects than 200 mg of prescription celecoxib in treating moderate to severe knee pain, albeit relief took longer to appear. At the same forum, it was reported that 1,500 mg glucosamine sulfate was superior to acetaminophen in relief. Both of these studies involved quite large dosages of supplements leaving open the question of whether such large amounts are necessary. The 2017 study demonstrated efficacy with a dose of chondroitin sulfate that was less than half of that which had been tested previously and shown to be effective.

Study Summary
Chondroitin sulfate is a sulfated glycosami¬noglycan composed of chains of alternating D-glu¬curonic acid and N-acetyl-Dgalactosamine.⁶ It is a major component of cartilage, a tissue in which it exists attached to proteoglycans. Proteoglycans are commonly described as looking like tree trunks with many branches to which are connected bottle brush-like bristles. Chondroitin sulfate is especially important in joint synovial fluid and for the fluid-retaining qualities of the proteoglycans.⁷ In the 2017 study, the primary issue was whether chondroitin sulfate could be effectively used for long-term treatment of osteoarthritis, in particular in an aging population.

For study purposes, 604 patients diagnosed with symptomatic knee osteoarthritis were randomly assigned to one of three daily treatments in what is known as a double-blind, double-dummy design. In the chondroitin sulfate group, 199 patients were given 800 mg chondroitin sulfate; the second group made up of 200 patients received 200 mg celecoxib; the third group consisting of 205 patients received dummy tablets. Pain, joint function, and overall patient acceptability were assessed using validated scoring systems on days 30, 91 and 182. Improvements in pain and joint function were significantly greater after six months (chondroitin sulfate) and three months (celecoxib). Joint function improved more quickly in patients taking celecoxib, but there were no overall differences in the effectiveness. The benefit-risk profile favored the chondroitin sulfate treatment, meaning benefits fewer or no side effects.

The authors of the study concluded that a daily dose of 800 mg of pharmaceutical-grade chondroitin sulfate was better than a dummy product and as good as celecoxib in reducing pain and improving joint function in symptomatic knee osteoarthritis. However, the researchers advised care in selecting the form of chondroitin sulfate utilized: "Chondroitin sulfate is available as pharmaceutical-grade and nutraceutical-grade products, the latter exhibiting striking variations in preparation, composition, purity as well as clinical effects." In other words, the quality of the vendor should be the guide to choosing a product.

Chondroitin Sulfate Heals More Than The Joints
Chondroitin sulfate has many roles in the body other than in contributing to the health of the joints. Connective tissues which depend upon chondroitin sulfate are widely dispersed, which is to say that they are found not only as cartilage, but also as bone, tendon, skin, blood vessel walls, and mucous membranes. Any one or all of these tissues may benefit from supplementation with chondroitin sulfate.

Atherosclerosis (hardening of the arteries) is a case in point. Over a six-year period in a study involving one hundred and twenty subjects already suffering from diagnosed atherosclerosis and undergoing medical treatment, the group which supplemented daily with 1,500 mg of chondroitin sulfate fared strikingly better. The supplemented group had only one third as many deaths (4 versus 13) and one seventh the number of total cardiovascular incidents of types (6 versus 42). Inasmuch as this study lasted for six years, the safety of a large daily ingestion of chondroitin sulfate also was shown.

Chondroitin sulfate has a number of effects that have been demonstrated, but not always clearly explained. For instance, mucopolysaccharides in some tests have proven to be interesting immunomodulators that increased immune activity when it was too low and helped to turn it down when it was too high, such as in autoimmune conditions. Chondroitin sulfate has anti-inflammatory benefits and wound healing benefits. Some tests have indicated that chondroitin sulfate can help to regulate normal cell division. The range of benefits becomes clearer when it is realized that the following items all contain forms of chondroitin: bone broths, bovine cartilage extracts, shark cartilage extracts, extracts from sea cucumber and the green-lipped mussel.

Conclusions
Bone broths no doubt date back to prehistoric times and are staples in a number of established medical systems, such as Traditional Chinese Medicine. The principles remain the same today as in centuries past. Mineral and protein-rich broths containing the building blocks of the digestive system and connective tissues are surprisingly versatile in helping the body to heal itself. Although modern medical research typically does not examine complex food such as bone broths, research into the benefits of individual components often yields impressive results. Chondroitin sulfate is a case in point. Properly made, even seemingly small amounts can yield joint health benefits equal to those found with modern drugs along with other benefits, such as for the cardiovascular system. But why depend on pills when you can brew bone broth yourself?

References:

1. http://www.townsendletter.com/FebMarch2005/broth0205.htm
2. Burton-Freeman B, Sesso HD. Whole food versus supplement: comparing the clinical evidence of tomato intake and lycopene supplementation on cardiovascular risk factors. Adv Nutr. 2014 Sep;5(5):457–85.
3. https://www.westonaprice.org/health-topics/why-broth-is-beautifulessential-roles-for-proline-glycine-and-gelatin/
4. Reginster JY, Dudler J, Blicharski T, Pavelka K. Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT). Ann Rheum Dis. 2017 May 22. pii: annrheumdis-2016–210860. doi: 10.1136/annrheumdis-2016–210860. [Epub ahead of print]
5. Pelletier JP, Raynauld JP, Beaulieu AD, Bessette L, Morin F, de Brum-Fernandes AJ, Delorme P, Dorais M, Paiement P, Abram F, Martel-Pelletier J. Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study. Arthritis Res Ther. 2016 Nov 3;18(1):256.
6. Martel-Pelletier J, Farran A, Montell E, et al. Discrepancies in composition and biological effects of different formulations of chondroitin sulfate. Molecules2015;20:4277–89.
7. Crolle G, D’Este E. Glucosamine sulphate for the management of arthrosis: a controlled clinical investigation. Curr Med Res Opin. 1980;7(2):104–9.

Okay, so golf isn’t your game; maybe its tennis, cycling, dancing, or simply a zest to live life to its fullest. Regardless of age, ethnicity, profession, or financial status, quality of life cannot be obtained while experiencing pain and inflammation, pain that affects the life of the victim, family and friends.

The world of medicine is undergoing a radical upheaval in its understanding of the debilitating, and often life-threatening, diseases of inflammation, including: heart disease, stroke, rheumatoid and osteoarthritis, multiple sclerosis, fibromyalgia, chronic fatigue, macular degeneration, Crohn’s, allergies, and much more.

Inflammation is the body’s way of telling us that something is terribly wrong—a basic defense triggered by bacteria, virus, parasites, injury, trauma, surgery, and chemicals (environmental or ingested). If the inflammation continues, pro-inflammatory cytokines are produced by macrophages, which are chemical messengers that attack and clean up cells in the affected area; eventually cytokine production rises, destroying more and more cells, leading to organ damage.

Structural Remodeling
Bone, a hard substance forming the framework around which the body is built, is the skeleton containing over 200 separate bones that support and shape to the body and protect its vital organs. The common misconception is that bone is “dead”; on the contrary, it’s a living substance and one of the most active tissues in the body, constantly being broken down and rebuilt by a process called remodeling. Therefore, in order for it to stay strong and healthy, it must have constant nourishment to:

• Keep the bone cells healthy and active
• Supply a variety for nutritional building blocks essential to form organic bone matrix
• Supply complex minerals needed to make up the hardened component of bone known as hydroxyapartite crystals.

The misconception exists that most mineral supplements are utilized by the body in the same manner. Not so. In my professional experience and research, the supplementation most effective is that derived from goat-milk whey, naturally predigested. This type of whey has been used for decades to promote bone density as well as to relieve aching, painful joints. This highly concentrated food powder contains a broad array of naturally occurring minerals, including sodium, potassium and calcium, in ratios used by the body with ease of digestion and absorption.

As we age, our ability to absorb calcium and minerals declines, therefore, supplementation must be bioavailable, i.e. easily absorbable.

With proper full-spectrum nutrition, healthy bones last a lifetime.

Protecting Your Shock-absorbers
Joints are designed to allow for smooth movement between the bones and to absorb the shock of jarring and/or repetitive movement. Joints consist of:

Cartilage—The substance that forms a firm, slippery coating at the end of each bone, cushioning it to allow joints to move easily
Muscles—Responsible for facilitating the movement of joints and keeping bones stable
Ligaments—Tough, cord-like tissues connecting bones
Tendons—Fibrous cords connecting muscles to bones, working with muscles to create movement of the joints.

According to the University of Florida Division of Rheumatology, there are more than 100 types of arthritis. That said, arthritis and other rheumatic conditions alone affect an estimated 43 million Americans, and that number is expected to climb to 60 million by the year 2020.

What most Americans reach for to help with pain and inflammation (the external effects) of arthritis, fibromyalgia and other inflammatory disorders are NSAIDs, a class of drugs including aspirin, ibuprofen, Vioxx, and Celebrex. The public was led to believe this class of drug is generally safe to take long-term. We now know different; the death statistics show otherwise. According to The Wall Street Journal (Apr. 19, 1999), every year 20,000 Americans die from the use of these drugs—higher than the number who die from HIV. (12,000 to 16,000 a year). In addition, another 100,000 Americans end up hospitalized with liver toxicity, kidney damage, and intestinal hemorrhage from the overuse of these drugs.

Painful Reflections
Unfortunately, this doctor is speaking from experience, after developing leaky gut syndrome as a result of prescribed NSAID use after a life-threatening accident and the subsequent injuries. Yes, NSAIDs are valuable in the short term after an injury, trauma or surgery; however, long-term use sets up the patient for disorders that not only alter their entire life (multiple allergic response syndrome/environmental illness) but also potentially place them in a life-threatening situation far worse than what precipitated the original need for the medications.

Hopeful Tomorrows
While prescription drugs provide short-term relief, they do not deal with the underlying causes. It makes perfect sense to look into a safe, effective nutraceutical option that contains comprehensive, time-tested ingredients all in ONE BLEND, as those identified in a blend listed below:

• Complete bone support formula with a broad array of naturally occurring minerals from goat milk whey to assist in maintaining chemical balance and to keep calcium in solution (fluid)—preventing it from depositing in joints
• Naturally occurring food-based cartilage building compounds of glucosamine and chondroitin sulfates
• Enzymes, such as protease, bromelain, papain, amylase, lipase and cellulase, known to reduce pain and inflammation
• Botanicals used for centuries known for their strong anti-inflammatory, alkalizing and antioxidant effects; ginger, turmeric, acerola cherry, cherry juice, valerian, lemon powder, and white willow bark (natural aspirin)
• Type II Chicken Collagen, a food-based source of collagen—the principle structure of protein in cartilage, possesses no known side-effects and provides maximum absorption for strength, flexibility and joint support. This collagen is derived from free-range chickens; free of growth hormones, antibiotics, pesticides and insecticides. Many other sources of glucosamine and chondroitin sulfates are from marine life (which has a much higher risk of contamination) or from sources that are not free-ranged—adding to the body’s toxic load
• A natural blend of predigested, bioactivated greens to support joint and cartilage matrix
• Naturally occurring minerals (including potassium, sodium and calcium) from both predigested and regular goat-milk whey to support joints and bone density
• Bone-building ingredients, such as calcium phosphate, L-carnitine, oat juice (natural silica) and alfalfa juice (glutenfree)
• Predigested beneficial microorganisms and active enzymes for gastrointestinal support.

The important components to achieving both short-term relief and long-term maintenance are to supplement with a natural, comprehensive, bone and joint health formula in order to provide the body what it needs to increase bone density while rebuilding healthy cartilage and connective tissue. Additionally, when it includes whole foods, herbs and enzymes for pain associated with inflammation, you are dealing with the causes of the pain, not merely masking it.

Alcohol: Depletes B vitamins and magnesium—needed by joint fluid and cartilage for proper function

Refined Sugar: Depletes B vitamins and trace minerals necessary for healthy joint cartilage and synovial fluid

Nightshade Foods: Inflame an inflammatory condition, and the symptoms can last as long as six weeks (tomatoes, potatoes, peppers—red, green, yellow, cayenne, and paprika, eggplant, blueberries, huckleberries, okra, and tobacco. For specific dietary information and nightshade-free recipes, refer to my book Pain/Inflammation MATTERS

Antacids: Depletes and neutralizes stomach digestive acids, which prevents the body from digesting calcium, proteins, and minerals that are essential for bone and cartilage repair.

No product can possibly guarantee it will allow you to again feel as good as “the good old days” without stiff, achy joints, swollen hands, knees, and ankles. If golfing, gardening, climbing stairs, dancing, or simply bending or walking have become challenging, dietary comprehensive supplement blends are available containing natural ingredients—many of which have been used for decades and present safe and effective quick relief as well as long-term maintenance, naturally.