Joint Degeneration and Arthritis

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Utilizing Complementary and Integrative Medicine in the treatment of Degenerative Joint Pathologies

Often, the advice from Medical Doctors to patients with progressive degenerative joint pathologies is to depend on pain medication and rest, and just wait until the situation becomes worse and requires some surgical intervention. Temporary relief is often achieved with pain medication, as well as corticosteroid injections, as the symptoms of degenerative joint pathology may come and go, depending on levels of stress and activity. These symptoms are only the tip of the iceberg, though, and the real danger is what lies under the water, which can sink the ship. Working directly on the degenerated tissue to stimulate healthy regenerative growth and function is often needed. Acupuncture stimulation assists direct soft tissue physiotherapies in this regard, as do herbal and nutrient medicines.

Achieving pain relief with medication does not mean that the degenerative joint condition is resolved, and when the patient focuses only on pain relief as a measure of success, this success is usually temporary. Dependence on pain relieving medication can be very harmful to the health and create other serious problems, such as stomach and gastrointestinal problems, and cardiovascular inflammation, as well as addicton. A whole treatment protocol, directed by a competent physician, utilizing physiotherapy, patient instruction, acupuncture, herbal prescription, dietary supplements and changes, and correction of postural mechanics is effective, especially when the physician, who is a Licensed Acupuncturist and hebalist, identifies contributing health problems and addresses these as well. The ultimate benefits of this comprehensive approach are many, and the patient will emerge with not only pain relief, but lasting tissue health, a healthier daily routine, and decreased risk of serious health problems related to aging.

The 2015 Oxford Textbook of Musculoskeletal Medicine, from the Oxford University School of Medicine, in the United Kingdom, offers substantial guidance in the standard treatment of degenerative joint conditions that is sensible. For instance, in the chapter concerning shoulder pathologies (Chapter 30, page 325), the treatment guidelines state: "The aims of treatment (for Frozen Shoulder or Adhesive Capsulitis) are pain relief and restoration of normal shoulder movement. Treatment should consist of one or more of the following: a) education and reassurance of the patient about the natural history of the condition and support with the use of analgesics or anti-inflammatories; b) physiotherapy with the use of (soft tissue) mobilization techniques or other modalities; c) the use of injection techniques with corticosteroid; d) manipulation under anesthesia." The time intensive treatment with patient education, soft tissue mobilization (Tui Na in TCM therapy), myofascial release (other modalities), and even herbal and nutrient medicine as anti-inflammatories is available from the TCM physician, or Licensed Acupuncturist, who is trained in these treatment modalities. The acupuncture stimulation included in such therapy provides stimulation of faster tissue healing by helping the natural processes in the body respond. The use of corticosteroid injection provides only temporary pain relief, but can be integrated with this TCM protocol to help the patient in receiving more direct physiotherapy on injured or degenerative and inflamed tissues with less discomfort, facilitating the treatment. The Tui Na physiotherapy provides gentle joint manipulation that can be gradually resolving of the capsulitis, especially accumulation of irritating calcium deposits and tissue adhesions, and can be accomplished over time without anesthesia. The manipulation suggested involves very strong joint manipulation in a single session aided by local anesthesia in a hospital or clinic. These are the proven therapies in 2015. The patient may choose to try the corticosteroid injection, but should use this to improve the responses to direct physiotherapy, not as a stand-alone treatment. The patient may choose to have orthopedic manipulation under local anesthesia, but to fully heal and address restoration of the joint, a short course of acupuncture and physiotherapy afterwards would be advisable as well.

An increasing array of scientific studies are demonstrating how acupuncture and electroacupuncture benefits patients with degenerative and rheumatic joint disease, and some of these can be seen in the section of this article entitled Additional Information and Links to Scientific Studies. Studies have consistently shown benefits on outcome studies with pain levels decreased and functional capacity increased over the last few decades with acupuncture, but this was often discounted by standard medicine as a placebo effect, or discounted for lack of double-blinding and use of an acupuncture placebo in human clinical trials, which is difficult, if not impossible to actually achieve with current study design, as obviously, designing a placebo needle stimulation that is blinded to both the patient and the treating physician is nearly impossible. Studies in recent years have also measured the chemical effects of acupuncture and electroacupuncture and found that remarkable benefits in clearing of pro-inflammatory cytokines, reactive oxygen species, and enzymes that drive degenerative joint disease are achieved. This is not a placebo effect. The cynical use of RCTs to discount acupuncture benefits by stating that they do not statistically outperform some so-called placebo acupuncture have been heavily criticized in recent years even in standard medicine, but these studies do still persist, concluding that acupuncture does not significantly outperform placebo, but does show evidence of effectiveness. Many other studies provide more objective and useful information. Some of these studies are cited below in additional information.

By 2014, acupuncture, physiotherapy, herbal and nutrient medicine were broadly accepted and included in the treatment protocols proven effective for knee osteoarthritic joint degeneration. This OARSI guideline (Osteoarthritis Research Society International), composed by a panel of 13 experts in various standard medical specialties from 10 countries, including the U.S. U.K and EuroZone, shows that physiotherapy and instruction in targeted exercise and stretch are recommended for all patients, and that capsaicin, mineral baths (baineotherapy), acupuncture, chondroitin, glucosamine, hyaluronic acid, nutrient medicines as unsaponifiables, and rosehip extract (Vitamin C) are recommended for subsets of patients with knee osteoarthritis. Standard treatment was limited to NSAIDS, acetaminophen, corticosteroids and weight management, which provide no real restorative effects at all. To see these guidelines, click here: http://www.ncbi.nlm.nih.gov/pubmed/24462672 . There should no longer be any doubt that a comprehensive TCM treatment protocol, combining physiotherapy, acupuncture, herbal and nutrient medicine, and instruction in targeted therapeutics and body mechanics is now recommended even by the most conservative voices in standard medicine, no matter the reluctance to endorse CIM/TCM. The negative discouragement of this protocol, safe and relatively inexpensive, with the only side effect being better overall health and disease prevention, should finally cease. It works, and patients should get to work and adopt a more intelligent and proactive attitude, rather than just suffer and wait till a prosthetic is required.

When utilizing an array of proven therapeutic measures, such as electroacupuncture, acupuncture, Tui na physiotherapy, and herbal/nutrient medicine, the measured effects in the body to correct the inflammatory dysregulation, clear oxidant free radicals, and promote regrowth of healthy tissues, such as cartilage, are achievable, but it does take a persistent and holistic approach, given the nature of bone cartilage. The combination of these therapies should be vastly superior to one protocol alone, and looking for the miracle supplement or cure is not sensible. This outcome with a professional holistic treatment protocol, compared to standard medicine and the use of NSAIDS with adverse effects and no chance of promoting healthy regrowth, or the replacement of the joint with a prosthetic, with only a limited number of years of function, and a poor long-term outcome, is obviously superior, and comes with no adverse effects. Persistence with therapy is the key, and requires an individualized treatment plan that fits the needs of each patient. Finding the right Complementary and Integrative Medicine (CIM/TCM) physician, or knowledgeable Licensed Acupuncturist and herbalist, to deliver these effective treatments combined in an individualized treatment protocol, and provide quality researched medicinal herbs and nutriceuticals, is the key.

The standard treatment for many of these common joint pathologies, such as lateral epicondalgia, adhesive capsulitis frozen shoulder syndrome, osteoathritic cartilage degeneration of the knee, and plantar fascia tendinopathies and arthropathies have not been effective, and expanded protocols are sorely needed. A 2009 randomized controlled human clinical trial of high quality, by experts at the University of Oslo School of Medicine, examining the efficacy of standard corticosteroid injections and standard physiotherapy in the treatment of acute lateral epicondylitis, with 157 patients completing the trial, concluded that standard "physiotherapy with deep transverse friction, Mills manipulation, stretching, and eccentric exercise showed no clear benefit, and corticosteroid injection gave no added benefit" (PMID: 25989985 - NCT00826462). The use of corticosteroid injections once again showed only temporary pain relief, and the standard types of physiotherapy showed temporary benefit only as well. The recommendation, unfortunately, involved the past findings that about three-fourths of these patients showed resolution after 52 weeks, or nearly a year, of resting their arm and elbow! This is obviously not a good set of outcomes. A more comprehensive and holistic protocol, involving soft tissue therapies such as myofascial release, active release techniques, soft tissue mobilization without irritating friction massage and Mills manipulation, as is common to Tui Na, and instruction in better body mechanics, as well as acupuncture stimulation, topical herbs, and oral herbal and nutrient medicines, would produce a better and lasting set of benefits. Addressing the whole syndrome of dysfunction as well, with attention to the thoracic outlet and impingement of the brachial plexus from chronically contracted muscles of the neck and shoulder would also offer better circulation of nutrients and better muscle firing in the arm. This holistic approach is not part of standard allopathic medicine, and is hard to test with current RCT study design. When the standard therapeutic protocol is proven to be ineffective for decades, it is finally time to think outside of the box.

An example of current research that proves the potential for Chinese Herbal Medicine in the holistic treatment regimen to achieve restoration of cartilage in degenerative joints is this 2014 review of study of the formula Er miao Tang with addition of Angelic pubescentis (Du huo) by experts at the China Academy of Chinese Medical Sciences, in Beijing, China. This randomized controlled study showed that the treatment with this formula for 3-6 weeks significantly inhibited articular joint cartilage damage and inflammation, and also increased expression of collagen, proteoglycan, and growth factors, providing broad benefits. To see this study, click here: http://www.ncbi.nlm.nih.gov/pubmed/25087604 . Er Miao San is a simple traditional formula containing Phellodendri cortex (Huang bai) and Atractylodis rhizome (Cang zhu), traditionally used for chronic low back and knee pain, and this set of herbs can be seen in most professional herbal formulas used to treat joint degneration in TCM practice. While standard medicine still reports that acupuncture stimulation has 'small benefits' in RCTs for osteoarthritic symptoms, they also report that standard treatment still shows almost no benefits. What is missing from this type of reporting is that actual TCM clinical care of degenerative joint conditions uses much more than a simple standardized and dumbed-down acupuncture treatment that is needed in the RCT design, but in reality, incorporates individualized short courses of acupuncture and electroacupuncture stimulation in a broad protocol. The acupuncture stimulation also provides an array of "small benefits" that address underlying health problems, not just palliative pain relief and immediate mobility. The most important aspect of this comprehensive and holistic treatment protocol in TCM for joint pathology though is the traditional soft tissue mobilization and joint manipulation, called Tui na in China. While the use of the human RCT has been successfully used to imply that these treatments do not achieve great results, there is no study of this comprehensive treatment protocol used in actual clinical care with the RCT design, as it is not allowed. The RCT design was created to test specific chemicals for safety and measure specific effects, in a one-size-fits-all treatment only, not actual holistic and comprehensive treatments and a broad set of effects, and the insistence of blinding both the treating physicians and the patients to the actual limited and one-size-fits-all treatment protocol studied to achieve comparison to some imaginary 'acupuncture placebo' makes these RCT studies even more inadequate to truthfully and realistically provide patients with real assessment.

Many patients do purchase supplements to help with their symptoms and healing, though, although the quality of unprofessional and unregulated herbal and nutrient supplements has been studied and found to be an alarming problem in the United States. Popular supplements and herbs are frequently advertised with exaggerated claims and give the patients false hope, and often do not contain what is advertised. Prescription of herbal formulas and nutriceuticals by a Complementary and Integrative (CIM/TCM) Physician with a Medical License and education in herbal medicine, and utilizing professional products, will be much more effective than products bought commercially (see the article on this website entitled Herbal and Nutrient Medicine: Quality Assurance). We only need to look at current research into biomarkers of disease for osteoarthritis and Degenerative Joint Disease to see that supplements like hyaluronic acid, amino acids, and collagen type 2 extracts are integral to this treatment protocol. Along with the proper herbal nutrient formulas, acupuncture and physiotherapy, there are a variety of specific herbs and supplements useful to achieve goals as well, and topical delivery to the joints is perhaps important as well. These herbal nutrient products are usually helpful but are not a cure by themselves, and quality varies considerably between products due to the lack of regulation by the FDA. Professional products insure quality control, and these are available only to the Licensed Acupuncturist and herbalist and other professional physicians. Here are the facts on some of the popular therapeutic aids available to the public:

Oral Glucosamine supplement: studies show that oral glucosamine had no effect of increasing glycosaminoglycan content when the cartilage was normal, but had some mild beneficial effect if the cartilage was in a rebuilding phase. Rebuilding cartilage has a much increased demand for glucosamine. Studies show that rates of collagen repair in the cartilage & meniscus were not affected by the amounts of oral glucosamine or injected glucosamine. These studies point to the fact that the patient must improve the body's response to tissue repair in order to utilize the glucosamine supplement, and then this supplement will be effective. Thus, oral glucosamine, or glucosamine delivered locally to the tissue, in the form of topical agents or injections, will benefit only as part of a program that improves the overall tissue repair response. In patients that have no rebuilding of cartilage or meniscus, the glucosamine supplement is a waste of money. When the patient utilizes a complete conservative care treatment plan with passive soft tissue mobilization, gentle breaking up of tissue adhesions, and various stimulation techniques, the cartilage goes into a rebuilding phase, and the glucosamine is utilized fully (refer to PubMed PMID: 12355498)

Cartilage extracts with Matrix Proteins: sharks cartilage and bovine cartilage extracts have been available for some years, and are the principal sources for many chondroitin sulphate supplements. In many cases of degenerative joint problems, these have been ineffective. Studies that looked at patients with autoimmune cartilage diseases such as Rheumatoid Arthritis and Polymyalgia Rheumatica showed that these supplements could be useful to modify the course of the disease. The studies showed little effect in cases where the degeneration or joint inflammation was induced by medication side effect. The effectiveness of the cartilage protein extracts was linked to the immune stimulation of proteoglycan synthesis, and thus, concurrent use of immune stimulants or modifiers that enhanced interleukin or other cytotoxic immune response could greatly improve the effect. Once again, alone, these supplements may not benefit, but integrated logically into a treatment plan, they may have dramatic results for the right patients.

Collagen extracts and antioxidants: when the joint is receiving physiotherapy, with gentle breaking of chronic adhesions and improved circulation, there is a great need for large amounts of collagen in joint tissue repair. Studies show that the tissues may need up to 80 times the normal supply of collagen. Along with this nutrient material, antioxidants are required to help with clearing of dead tissues and debris. I use Health Concerns Collagenex 2 to supply usable collagen type 2 (glucosamine, chondroitin etc.) derived from compatible tissue extracts from the chicken, and delivered in a patented encapsulation discovered by many years of research at Harvard Medical College. The concurrent use of a potent tissue antioxidant supplement is also recommended, such as pomegranate extract. I also utilize a topical herbal cream that delivers glucosamine and chrondroitin with the carriers MSM and emu oil, so that these nutrients can get to the tissues directly. When used within the course of physiotherapy, this combination can benefit tissue repair greatly.

Hyaluronic acid injections: while hyaluronic acid (HLA) is utilized in injections for treatment of degenerated cartilage and joint tissues, these single injections are found to be of questionable value. HLA is a chemical in our cells that helps with cell hydration. A molecule of HLA may attract up to 1000 times its volume in water. Our cells create more HLA receptors when there is a problem with cell hydration, and HLA in circulation is proven to attach to receptors to help restore the hydration of dry cells. Dry cartilage cells are a primary problem in cartilage degeneration, and chondroitin sulfate produced by these cells also helps to retain water in the cartilage cells, or chondrocytes. Use of an HLA serum may supply needed hydration to these cells.

Hyaluronic acid or HLA/HA serum or capsules: Hyaluronic acid is a potent extracellular matric molecule that has a number of beneficial functions, including the adherence of fluid, and may bind up to 1000 times its molecular weight in water. HLA is found in many tissues, including cartilage, and is integral to cartilage health, function and repair. Much research has been conducted in recent years to deliver HLA to diseased and degenerative joints. HLA serum was developed to apply topically to the skin and shown to carry quickly to a large number of HLA receptors. An oral HLA delivery system was also developed, leading to promise in supplying the degenerative joint and cartilage with more HLA when needed. Study at such prestigious medical universities as Johns Hopkins has proven that this may be a significant aid to the overall protocol to restore cartilage. To see a link to this study, click here: http://www.ncbi.nlm.nih.gov/pubmed/22724901?dopt=Abstract

Maca and Cat's Claw: studies have shown significant benefit for cartilage repair with the use of these herbs. Of course, cartilage cells, or chondrocytes, will not regrow until manually stimulated. Studies have also shown that chondrocytes will regrow when the tissue is stimulated with gentle cross-fiber massage, or if this is not possible, with passive joint mobilization techniques and electrical stimulation. Studies showed enhanced mRNA (insulin like growth factor) expression and production in human chondrocytes when joint mobilization was utilized, and certain herbal chemicals have shown efficacy in promoting insulin like growth factor as well.

Gotu Kola: this herb has also demonstrated significant benefit in regrowth of joint tissues and cartilage. Chemicals act on collagen formation, anti-inflammatory activity, and antioxidant clearing. Amino acids and triterpenoids in Gotu Kola are considered to be essential to tissue healing. If there is a problem with varicosities or veinous insufficiency, combine this with Butcher's broom and Stone Root (Formula V).

Amino acids: certain amino acids are essential for repair of soft tissue such as ligament and tendons. L-Arginine, L-Lysine, L-Leucine and L-isoleucine are all effective, and should be combined with Vitamin B6 to increase utilization. The olympic swimmer Dara Torres claimed that an amino acid formula was extremely helpful in healing her tissues and helping her get to another Olympic tournament at age 41. Whey protein is a common source of amino acids.

Leucine amino acid plus Chinese herbs: a 2011 study, cited below, found that combining L-leucine with 3 standard Chinese herbs, Boswellia carterii (Gummi Olibanum, or Ru xiang, frankincense tree resin), Uncaria tomentosa (Gou teng, or Cat's Claw in Peru), and Lepidium meyenii (Maca, or Lepidium micrathum, apetalum or latifolium in China, Ting li zi), exerted significant cartilage-protective and anti-inflammatory actions, switching cartilage cell (chondrocyte) gene expression from catabolic to anabolic pathways (destructive to regenerative). Prior studies found that Uncaria and Lepidium (Cat's Claw and Maca) exerted a cartilage regenerating effect. The Chinese herbs Epimedium, or Yin yang huo, has also been proven in a number of studies to aid cartilage regeneration, and a variety of Chinese herbs traditionally used for arthritis are being studied at this time to prove efficacy as well. Lack of scientific studies is due to the cost of the process of staged in vivo and in vitro studies progressing to large double-blinded, placebo-controlled human clinical trials. Since the profit in herbal medicine is small, the field has not been able to duplicate the outrageously expensive clinical trial programs used in pharmaceutical medicine, and with thousands of years of clinical empirical evidence to support the herbal efficacy, was not considered a priority. These clinical trial programs often cost billions of dollars for new pharmaceuticals, but many experts state that these costs are inflated to justify the enormous prices of new pharmaceuticals. Herbal medicine, especially from China, is still devoted to the delivery of effective herbal medicines at a ridiculously low cost. The amino acid leucine is found in sunflower seed, watercress, soy, various fresh and dried beans, acacia, carob, fennel, coriander, cumin, taro, fava bean, pumpkin seed, and lentils. We see that a variety of cold-pressed fresh seed oils will deliver useful leucine, making pumpkin seed oil and unprocessed sunflower seed oil a healthy addition to the diet.

Boswellia and turmeric: Boswellia is the Chinese medicinal herb Ru xiang, olibanum gum, or boswellia carterii or serrata, commonly called frankincense tree resin. Frankincense is famous as one of the expensive offerings the Magi brought to the birth of Jesus, and at that time in history was a valuable trade commodity because of its amazing healing properties and use to quickly heal battle wounds. Turmeric, or curcumin, is also a Chinese medicinal herb. In fact three common Chinese medicinal herbs are curcumins, E zhu, Yu jin, and Jiang huang (turmeric), and are used to aid tissue repair, decrease inflammation, benefit circulation, help clear cancer and tissue growths, and aid the liver function. These herbs are now well studied in relation to cartilage growth and chronic inflammatory disease. Formulas, such as Back in Action from Vitamin Research Products, add nattokinase and DLPA (DL-phenylalanine) to form a more comprehensive treatment protocol in clearing the joint tissues, relieving pain, and aiding healthy regrowth. A study cited below, from the University of Liege, Belgium, states: "curcumin and structurally related biochemicals may become safer and more suitable nutraceutical alternatives to the non-steroidal anti-inflammatory drugs that are currently used for the treatment of osteoarthritis." (Henrotin Y et al). These herbs have long been used in Chinese medicinal formulas to treat joint pathologies.

Manganese or Manganese SOD: manganese deficiency has been shown to be a significant factor in many cases of degenerative cartilage. Manganese deficiency results in the poor utilization of chondroitin, glucosamine and other mucopolysaccharides in the normal repair and maintenance of cartilage. Manganese SOD (super oxide dismutase) is a combination of a potent antioxidant with manganese, and thus may aid cartilage repair even more. Manganese is more commonly available in essential mineral supplements, some of which contain other nutrients beneficial to cartilage repair, such as Vitamin K (phytonadione), calcium hydroxyapatite, zinc monomethionine, and boron (Vitamin Research is a good professional source: Advanced Essential Minerals or Optimum D). Manganese SOD, or superoxide dismutase, is now difficult to find as a supplement. Concurrent use of a manganese supplement with an SOD source, such as dried barley sprouts, is recommended. Current research shows that angiotensin II, a protein that chronically stimulates higher blood pressure with adrenal hypertension, may both create more superoxide radicals and inhibit SOD in tissues. Treating adrenal stress syndrome may also be indirectly helpful for the healthy maintenance of degenerative tissues.

Proteolytic enzymes: Serratiopeptidase and Seaprose-S are two researched enzymes that help clear the rebuilding tissues and are proven to aid in both cartilage repair and decrease in chronic joint pain with a long course of use. Nattokinase is another heavily researched proteolytic enzyme that is becoming popular. A study (cited below) by the Pritzker School of Medicine of the University of Chicago, found in 1975 that enzyme treatment was an important factor in the responsiveness of cartilage cells, or chondrocytes, to stimulate greater production of chondrointin sulfate proteoglygan, or aggrecan.

Pomegranate extract with seed oil and polyphenol antioxidants enhanced by fermentation: a study by the Case Western Reserve University School of Medicine, published in the September 2005 issue of the Journal of Nutrition, demonstates that a properly prepared concentrated extract of pomegranate exherts significant antioxidant and anti-inflammatory properties, such as the inhibition of interleukin 1b, which plays a key role in cartilage degeneration in osteoarthritis. Polyphenols in whole pomegranate extract include anthocyanins, catechins, and punicalagins (a source of ellagic acid), which are now well studied and proven to be highly effective in many disease states other than tissue degeneration as well, such as cardiovascular disease, atherosclerosis, and cancer prevention. Use of this supplement will help to decrease the rate of cartilage degeneration, as well as speed growth of new healthy tissues by clearing oxidant radicals.

Procyanidin B3 in grape seed extract: study in 2011 at Keio University and Tokyo Medial and Dental University (cited below) showed that procyanidin B3 grape seed extract prevented cartilage destruction in animal studies. This was achieved in part through suppression of iNOS (inducible nitric oxide synthase), which is linked to the high expression of matrix metalloproteinases (MMPs) seen in osteoarthritis.

Boron and Vitamin D3: boron along with activated vitamin D3 hormone may increase cartilage formation. Boron helps regulate calcium metabolism and helps activate estrogen and vitamin D3, as well, preventing tissue calcification and aiding tissue repair. Food sources of boron include dates, raisins, prunes, almonds, hazelnuts and honey. Like many individuals, you may be deficient in activated vitamin D3, which is a hormone activated by exposure to sunlight on circulating D3. A simple blood stick test is available to determine D3 deficiency. Daily exposure to sunlight on the face and arms for 10 minutes insures activation, and so a midday walk in the sun is helpful. Exposure through glass in the car or office is not effective. You might take a cholecalciferol D3 supplement as well as chelated boron supplement combined with amino acids to aid utilization. Current study on boron supplementation is insufficient to definitively confirm that boron supplementation will treat arthritic conditons. Vitamin D3 is not really a vitamin, but rather a prohormone. D3 cholecalciferol is created daily in your body by exposure to sunlight, health cholesterol metabolism, and minimally from food sources. This cholecalciferol goes to the kidney to produce hormone D3. Two types of D3 hormone are known to science, and recent research has found that one isomer is integral to cartilage remodeling, regulating the basement membrane of the cartilage near the bone, and may be responsible for successful cartilage remodeling and repair. Since D3 hormone is tightly regulated in your body, not only supplementation with cholecalciferol and increased midday sun exposure is recommended, but also treatment to correct hormonal imbalances and improve the functions of the kidney and liver metabolism. Studies show that a high percentage of the population is deficient in D3. Utilize a holistic medical regimen to best advantage when taking these supplements. Deficiency of Vitamin D3 hormone is very widespread now in the United States, and could lead to a hormonal deficiency that affects the D3 hormone that regulates cartilage remodeling. Supplements with both D3 and boron are available. Coral 3X by Vitamin Research contains 1200IU cholecalciferol (Vitamin D3) plus 4mg of boron, with ascorbic acid (Vitamin C), calcium and a balanced array of minerals from coral, including magnesium, all of which may benefit joint tissue repair.