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:
- http://www.townsendletter.com/FebMarch2005/broth0205.htm
- 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.
- https://www.westonaprice.org/health-topics/why-broth-is-beautifulessential-roles-for-proline-glycine-and-gelatin/
- 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]
- 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.
- 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.
- 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.