Curcumin, glucosamine, chondroitin, Boswellia, methylsulfonylmethane (MSM), and fish oil are some of the most common ingredients for symptomatic management of osteoarthritis.
However, some of these ingredients such as curcumin and Boswellia target mainly two out of three pathologies that contribute to osteoarthritis.
Novita Puspasari, scientific affairs manager, H&H Group, pointed out the above during her presentation at the Growth Asia Summit 2024 held in Singapore between July 16 and 18.
She was speaking on the topic “Mobility and pain management: An evidence-based approach to managing mild to moderate osteoarthritis through supplementation”.
Using the company’s latest joint health product Swisse Ultiboost High Strength Krill Oil launched this year as an example, she spoke about the rationale for using krill oil as the key ingredient.
The product, which was granted the listed assessed status by Australia's Therapeutic Goods Administration (TGA), claims to “relieve knee pain in mild to moderate osteoarthritis.”
It adds to the brand’s existing range of joint health supplements that uses other ingredients, such as Swisse Joint Repair which uses glucosamine and chondroitin. The product claims to “help reduce cartilage damage”, “mild osteoarthritis symptom relief”, and “supports joint mobility”.
There are three key mechanisms involved in the onset of osteoarthritis, Puspasari pointed out.
They are 1) an increase in inflammation, 2) a reduction in structural support, and 3) an impaired repair system.
Ingredients such as curcumin work by reducing inflammation.
It also improves structural support by lowering the number of enzymes that break down collagen. An example of such enzymes is matrix metalloproteinases (MMPs) and A Disintegrin And Metalloproteinase with Thrombospondin motifs (ADAMTS) which break down proteoglycan – the major component of connective tissue.
Despite the above benefits, curcumin is lacking in its ability in building up the joint repair system – which is the other key mechanism involved in osteoarthritis, said Puspasari.
“Although the pathologies [behind osteoarthritis] have not been fully elucidated, there is an acknowledgement that osteoarthritis actually starts from molecular derangement,” she said.
“Some examples of the derangement would be degradation, abnormal bone remodelling, loss of normal joint function, joint inflammation, as well as osteophyte formation. However, underlying all these, there's a cascade of reactions that's happening,” she said, referring to the three aforementioned mechanisms.
“All these factors interplay with each other, not in isolation,” she highlighted.
Krill oil, like glucosamine, chondroitin, MSM, and fish oil, relieves symptoms of osteoarthritis via the three mechanisms.
For instance, krill oil has been shown to reduce inflammatory cytokines, lower the production of proteases responsible for breaking down collagen, and could promote anabolic growth factors that play a part in the repair system.
Glucosamine similarly addresses joint discomfort linked to osteoarthritis by reducing inflammatory markers, preventing collagen degeneration, and increasing the mRNA levels of anabolic growth factors.
However, krill oil stood out as it is rich in the antioxidant astaxanthin.
In addition, as compared to fish oil which comes in the triglyceride form, it is also better absorbed due to its phospholipid structure – which is the same structure as human cell membranes.
“There's also preferential uptake [of krill oil] into the liver, as compared to other sources of omega-3,” she added.
Developing a higher-level claim product
Tapping on the benefits of krill oil, the company launched Swisse Ultiboost High Strength Krill Oil which differs from its existing range as it could make a higher-level health claim.
Before its launch, Swisse also had another krill oil product known as "High Strength Deep Sea Krill Oil". However, it does not make health claims related to osteoarthritis, but only those surrounding heart, brain, and eye health.
The new Swisse Ultiboost High Strength Krill Oil is designed for individuals with mild to moderate osteoarthritis, compared to Swisse's other joint health related products which can only claim to relieve symptoms of mild osteoarthritis.
The company has been able to do so by backing up the product with findings from a six-month randomised, placebo-controlled, double-blind clinical trial.
Conducted together with its krill oil supplier Aker Biomarine and the Commonwealth Scientific and Industrial Research Organisation (CSIRO), the trial assessed how taking four grams of krill oil daily could improve knee pain in people with mild to moderate knee osteoarthritis.
This is equivalent to taking 0.60g of EPA, 0.28g of DHA, and 0.45mg of astaxanthin each day.
The other parameters measured were knee stiffness and physical function.
Findings published in The American Journal of Clinical Nutrition showed that the intervention group had increased omega-3 index and greater improvements in knee pain score. They also had greater improvements in knee stiffness and physical function as compared to the placebo group.
“Individuals who suffered from high inflammation at the start benefitted more from the supplementation, indicating that inflammation and pain are closely linked,” she added.
With this, the company applied for a higher claim through Australia’s AUST-L(A) pathway.
Referring 'assessed listed', AUST-L(A) products have had their health claims assessed for efficacy. They can also enjoy five-year exclusivity to the claims made.
“We then took this opportunity with the positive result to get through the AUST-L(A) pathway.
“With the support of the ingredient supplier, we submitted a new claim which says that krill oil significantly reduced knee pain, improved knee stiffness and physical mobility in individuals with mild to moderate osteoarthritis,” said Puspasari. The claim was approved last August.
At the moment, the majority of health supplements in Australia are AUST-L or listed medicines, meaning they have not been assessed for efficacy.
As of last October, only three products have secured the listed assessed status, including Swisse’s product and two other products from Caruso’s Natural Health.