Joint and Tissue Repair
Joint and Tissue Repair
Joint and Tissue Repair
GAGS: Glycosaminoglycans
Making new connective tissue is all about something called GAGs. That stands for
glycosaminoglycans which are primarily a bunch of sugar molecules linked together.
They come from what is known as the glycolytic pathway thats the same pathway you
use to make energy from sugar in your body.
Connective tissue is fibrous tissue found throughout your body in the form of tendons,
and the framework of fibers in muscles, ligaments, bone, cartilage, and even blood and
lymph tissue. Connective tissue not only connects body tissue together, but it protects
organs and even stores energy. All tissues in the body, with the exception of teeth, can
be repaired. Some tissue, such as liver tissue and bone, can even be regenerated.
broth. But you also make glucosamine naturally through the glycolytic pathway
(mentioned previously) with nutrients such as vitamins B1, B2, B3, and B5, as well as
magnesium, lipoic acid, and potassium. Glutamine, which is an amino acid our bodies
can synthesize, is also necessary and added into this step. Lets learn more!
Glutamine
Glutamine is the most abundant naturally occurring, non-essential amino acid. Its been
shown to be useful in the treatment of serious illnesses, injury, trauma, and burns.
Glutamine is also used by many athletes as a supplement because evidence indicates
that glutamine may increase plasma human growth hormone levels by stimulating the
pituitary gland, which in turn increases muscle growth. A healthy individual has plenty of
glutamine.
is readily absorbed into the skin so it is often used as a drug delivery system. DMSO, a
byproduct of paper manufacturing, was banned for some time by the FDA and allowed
only in veterinary medicine, primarily equine vet care. Its high in sulfur, which is why it
can help with tissue repair and is known for its distinctive smell some say it smells like
garlic, others say rotten milk, and Ive even heard old socks. You will stink! I can attest to
the smell first-hand as I used DMSO a lot throughout my high school and college years
as I was always injured. Skin burns are also very common using DMSO especially if its
mixed with a NSAID and then applied directly to the injured area, as many athletes do.
So if you are having joint pain or a connective tissue problem, especially the common
cartilage degeneration, what do you do? Do you take glucosamine sulfate? Chondroitin
sulfate? MSM? DMSO? Cysteine or glutamine? Taking all the nutrients I just mentioned
wont be practical, and multi-supplements wont work. Its more important to realize how
you got to the point of even seeking out these supplements in the first place, and what
you can do to possibly reverse and prevent further tissue and joint degeneration. Lets
look at the anatomy of an injury to understand this more.
(fish, grass fed beef, flax, eggs, avocado, nuts, seeds, coconut, butter, olive oil), and a
low grain and sugar diet will help you use fat primarily as a fuel allowing the body to
focus on making glucosamine and GAGs. That means the less stress youre under and
the healthier you eat, the healthier your joints will be! I think a Paleo-Type Diet is great to
implement here. This GAGs process is not just inhibited by cortisol, but also estrogen as
well as certain drugs such as anticoagulants, immune-suppressive agents, and
antibiotics. Ladies, that means youre more susceptible to joint issues than us guys, due
to your estrogen levels, and youll be even more at risk if you take birth control pills or
other hormonal replacement drugs.
When it comes to repairing an injury, or making sure an injury doesnt surprise you
tomorrow, youve also got to have sulfation and glucuronidation working well for you as
Ive talked about. So remember that glucuronidation has to do with liver detoxification of
hormones, drugs, and other pollutants. So the less environmental stress youre under
(think air pollution, for example), the less medications you take, and the less cortisol you
make (because youve dealt with stress levels), the more you have glucuronidation
working for you. Now for the sulfation part
Sulfates as a reminder, are present in foods such as broccoli, cauliflower, garlic,
cabbage, onions, radishes, and mustard. But more importantly, sulfates are also
depleted during high stress levels too because they are needed to detoxify cortisol in the
liver. Do you see a pattern here? I sure hope so. If you are under a lot of stress then
cortisol really makes a mess of every part of this GAGs pathway! The key is to not
deplete more sulfur than you take in. Interesting is the fact that NSAIDs restrict sulfate
availability, so cartilage cannot be repaired. This is a shocking fact for many people who
are trying to help their injury with these drugs, (aspirin and ibuprofen) yet are actually
doing more harm than good by depleting their sulfate levels. Research shows that
NSAIDs are only beneficial 2-3 days after injury. Taking them longer, or for the many
that take them every day, is inviting greater problems later in life. Deficiency of the trace
mineral molybdenum also inhibits sulfate availability.
Once glucose is available, because it was allowed inside the cells since youve
managed your stress, (normal cortisol levels), your body can make glucosamine and
then ultimately make chondroitin, which will happen because youve got good
glucuronidation going on. This all looks for the sulfur, (which is present when there are
also low stress levels and no signs of NSAID abuse), to make chondroitin sulfate the
ultimate prize in injury repair. And of course we needed some glutamine along the way
but we have plenty of that because a healthy individual naturally makes more than
enough and is getting some in their diet beef, chicken, fish, eggs, dairy products,
cabbage, beets, beans, spinach, and parsley.
The big idea here is actually very simple in such a complex way. You have to embrace a
healthy lifestyle because it all is going to affect the health of your tissues and joints.
Make sure your diet contains some of the foods mentioned so you have the resources
available to make GAGs happen. Consider looking at individual nutrients you may be
deficient in to help you repair your tissue. Deal with your excess stress whether thats
adjusting your training, diet, or lifestyle. If you take one of the joint/cartilage supplements
and it benefits you thats fine as it may be very necessary to get you going in the right
direction; its better than taking some drug to deal with your problem, but you should still
investigate why you arent making the substance on your own to truly fix your health
problem. The GAGs lesson is over.
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Filed Under: Diet & Nutrition, Injury Prevention & Treatment Tagged With: aerobic, anaerobic, carbohydrate
intolerance, chondroitin sulfate, cysteine, DMSO, GAGs, glucosamine, Glutamine, glycolytic pathway,
glycosaminoglycans, insulin resistance, MSM, natural running, NSAIDS, sulfation
Comments
1.
Michael says:
October 19, 2011 at 10:31 am
Yet another extremely valuable post by Dr. Gangemi. The internet makes it possible to disseminate so much
mistruth and hype (usually with an ulterior motive) and it is refreshing to know there are still people like Dr.
Gangemi out there who care about our long term well being, health and do not seek to profit from it. While Dr.
Gangemi does make a very nice living through his practice, this is but one example of how he gives back with
no expectation of anything in return. Thank you Dr. Gangemi.
2.
Tracy says:
October 19, 2011 at 11:17 am
So, would you think that if I am eating Paleo (8 mo now) and running barefoot and aerobically (using Maffetones
MAF heartrate), I dont need to be taking the Glucosamine/Chondroitin Ive taken for years? (49 yo female with
history of arthritis and osteoporosis in the family starting to feel pain in my feet upon waking about 10 yrs ago,
thats when I started taking Gluco/Chond).
Obviously not medical advice in this forum, but your general sense?
Correct, in a general sense there should be no reason to take it anymore, unless you have a specific nutrient
deficiency. For example, did you notice how I mentioned the active form of folic acid? 5-Methyltetrahydrofolate
(5MTHF) is what your body is supposed to convert folic acid into when you take it and its the form found
naturally in fruits and veges. But most people dont eat enough fruits and veges to get their necessary amounts
AND it is known that at least 10-15% of the population have a genetic mutation that does not allow them to fully
make 5MTHF, and 20-30% of the population is said to have a single gene mutation which makes it more
difficult for them to make 5MTHF. So, in this case a person may not be making enough cartilage repairing
tissue because they arent methylating their folic acid (B12 too) correctly. So if they dont get enough naturally
from their diet or from taking 5MTHF (not the typical folic found in most supplements), then there could be
issues. Other genetic issues can occur to making it necessary for individuals to need certain nutrients more
than others.
One more point an important one I did not address in the post. Taking this stuff month after month, especially
year after year is not healthy. I have seen numerous patients react to these supplements, most often with
problems in their pancreas (blood sugar metabolism makes sense as you learned from reading the post). So
dont think that more is better. It isnt. And definitely dont think that if it doesnt work then it wont cause a
problem, because it very well could be, especially after all those years.
Tracy says:
October 20, 2011 at 4:29 am
That is interesting. I must say, Ive definitely taken the it cant hurt approach. My problem now is that I am
working as a volunteer and where I live, it is very expensive. This month, Im skating on the edge of running
out of food. So buying an expensive supplement that might not be necessary doesnt seem wise. I think Ill
finish what I have and then stop it for awhile and see what happens.
Now, any opinions about Vitamin C?
sqt says:
October 30, 2011 at 8:25 pm
I think I have one of those genetic mutations you speak of (Ehlers Danlos syndrome). Ive been going Paleo for
a few months and have seen a significant reduction in pain. But I wonder if my body is capable of rebuilding
itself thanks to my faulty genetics. Supplementation doesnt really work for me because my system is very
sensitive and I react badly to most of them. Do you have any experience with collagen disorders and/or have
any suggestions?
3.
Nick says:
October 19, 2011 at 11:47 pm
You should add that oral glucoseamine > glucose as well. To big a bolus its a pretty good OGTT
4.
5.
Thanks Greg, I assume youre referring to LDL cholesterol which would make sense as, per my response to
one of the other comments, glucosamine can cause blood sugar issues, which in turn, will negatively affects
cholesterol levels by oxidizing LDLs. Not a good thing.
6.
Fiona says:
October 30, 2011 at 11:36 am
This is so interesting, and neatly explains my own experience.
I had the beginnings of a DuPutrens contracture on my left hand, and it had begun to progress towards the
cording stage. Around this time I was diagnosed with Pre-diabetes and I understand that Dupuytrens
contracture is regarded as an indicator of incipient Diabetes. (My Mom is a Type 2 Diabetic and she has a
Dupuytrens contracture too).
I started eating Paleo about 4 months ago, and along with weight loss, increased energy and improved blood
sugar control, Im certain the Dupuytrens contracture is resolving!
I had thought I must be imagining it, but now I know that my body is healing itself. Thanks so much for the
information.
7.
primalpal says:
October 30, 2011 at 11:48 am
Hi Sock Doc,
You mentioned that anticoagulants can interfere with the GAGs process. My father had a heart attack at the age
of 41from the outside he appeared to be in perfect shapehe had low cholesterolbut was under a lot of
stress at work at the time. This happened 10 years ago. He is now off of all statins (typical treatment even
though he didnt have cholesterol issues) and most of the other drugs (not sure what these were), but he is still
required to take coumadin, an anticoagulant. This is because he originally went off of everything (including the
coumadin) a year after his heart attack, and a few months later, he had to go to the hospital because a clot had
formed in his damaged ventricle (the blood was just pooling there because the heart is no longer able to pump
there). The doctors decided it was best that he stay on the coumadin indefinitely. Now he complains of sore
joints, stiff legs, etc. Is there anything that can counter the effects of the coumadin on this process without
reducing the benefits it has for preventing clots? I dont think he will be able to go off the coumadin unless his
heart can be repaired, but hopefully he can become more mobile than he is now. He loves being active, but the
joint pain and stiffness really prevent him from being able to do these things.
Thank you!
8.
Good luck.
Lizzie B says:
October 31, 2011 at 12:02 am
Just followed the link over from Marks Daily Apple. Amazed that I understood all the biochem, great job
explaining it so all can get it. Was just tickled that you KNOW the history on DMSO. It seems usually people
dont know what it is, where its from, or how it has been used for so long. Cant wait till they use it IV in people.
Only saying that because it has been run IV in Equines as a last ditch effort and brought the horses out of the
woods.
Now I just need to use up the mineral supplement I have that includes MSM with Glucosamine. Then switch to
the stuff that is just minerals. (Still working on eating a better diet until I get that leveled out, the minerals seem
to help fill in the gaps.)
9.
brian p says:
November 13, 2011 at 9:53 am
Do the same issues apply to disc damage such as a bulging disc in the lower back?
Will prolonged use of NSAIDs slow the healing of disc tissue?
and lastly, would cortisol injections (to control inflammation in a disc) also impair the tissue regeneration?
Great article, thanks for all the interesting info!
brian p says:
November 13, 2011 at 10:29 pm
Thank you for the quick reply. It is all very helpful!
10.
Feetqi says:
April 1, 2012 at 10:59 pm
I am in WOW but not finished the article let alone the posts! TCM ( chinese medicine) links the liver with joint
problems. But I have never found any other corroborative info!
I have history of tendon / ligament damage since taking up running 35 years ago, orthotics for 32, MCS for 30
years and recent diag. of pre-diabetes (insulin resistance).
I have dealt with these piecemeal as the holistic practitioners were not holistic enough! I have been on glutamine
supplements for the liver abnormality for 5 years- personally i think they stimulate appetite. But did not prevent
current foot injury! We really have to understand that we have to remove the bad things as well as put in the
good things. Piecemeal cannot work.
I so agree with your views Mr SocDoc !!!
11.
Cheryl says:
September 8, 2012 at 10:52 pm
Hello,
I was wondering if you have any recommendations for Mortons Neuroma. I injured BOTH feet this past January
and have had 1 Cortisone shot, TENS, ultrasound, and massage therapy all to no avail. I started in June taking
serrapeptase, B-50, and Tumeric.Curcumin which seems to have provided some relief, however, if I am walking
for any length of time over a half hour the cramping nerve pain returns. I amalso receiving HPLT (high powered
laser treatment) once a week that supposedly will help. What is your take on these modalities? I am terrified of
the alcohol shots an or thee surgery the podiatrist mentioned if conservative measures failed; it being only 70%
effective. I dont like those odds!!
I appreciate your comments.
12.
13.
what do you think about osteo bi flex & its ingredients (i read the side effects, and based on my family
history/personal history, im pretty sure im safe):
http://www.costco.com/Osteo-Bi-Flex%C2%AE-Triple-Strength,-170-Caplets.product.100013549.html
in 2008 an MRI stated i have intense bone marrow edema, chondral fissuring, interruption of subchondral bone
plate @ the end of the big toe proximal phalanx. my 2008 flare up was pretty bad (it prevented dorsi flexion).
2010 it flared up mildly. 2012 it flared up lightly. i noticed that there was a correlation with eating foods high in
uric acid too, my blood tests confirmed that i had slightly high uric acid levels to which im now taking allipurinol. i
never had a gout outbreak though. i have been going 2-3 years strong of increasing my diet to alot of
fruit/veggies/no gluten. i take fish oils daily. ive also been controlling my stress alot.
main reason for inquiring about osteo bi flex is that i want to thicken the cartilage at the end of the proximal
phalanx since there was intense wear and tear in 2008 and ive had mild flare ups since. if you do not
recommend osteo bi flex, is there any supplement out there that can increase my cartilage and create
healthiness between my 1st meta and proximal phalanx of my big toe? thank you so much dr gangemi!
sincerely,
cliff
14.
15.
duke says:
May 12, 2013 at 9:07 pm
Thanks for the post doc. I believe In what you are saying. I was recently told I have two disk protrusions in
lumbar. I was hurt while training jiu jitsu-as I was put in body lock. Disks are showing signs of degeneration. Pain
is mild without exercises. When I exercise I get increased pain and tightness. I went through heavy break up and
am a pretty stressed worried individual. I usually handled this stress via excercise. I have been a vegetarian my
whole life,I am currently 27. My Pt gave me McKenzie stretches for my posterior bulges along with sstretches. I
am going to purchase glucosomine and chondroitin in hopes of slowing or arresting disk degeneration. You say
that stretching is bad. Do you have any advice? Obviously I need to destress. Having a degenerative condition
doesnt help. Thanks very much for your time.
16.
KL Lim says:
May 31, 2013 at 9:47 am
Some supplement claims that thier supplement provides necessary nutrition for body to produce glucosamine. I
like to know how much supplement is sufficient for body to produce enough glucosamine for the body? will there
be a case that the body cannot produce glucosamine or little amount of glucosamine even with ample supply of
the necessary nutrition?
Is it possible that the body may have difficulty to produce glucosamine? What will be the causes? Is age one of
the causes? How to find out if the body having this difficulty?
If body is having difficulty to produce glucosamine, what can be the solution? Take the ready made glucosamine
pill like Viatril-s or bio-calth?
Thank you very much.
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