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Ingredient Details

Raw salmon fillet
Raw salmon fillet

Omega-3 (EPA and DHA)

EPA and DHA are essential omega-3 fatty acids from fish oil that are well known to promote healthy inflammatory balance. By acting as substrates for the body’s various anti-inflammatory mediators, EPA and DHA address inflammatory processes as well as natural tissue repair processes. Studies provide some evidence that EPA and DHA help reduce minor pain associated with musculoskeletal exercise-induced inflammatory conditions.

1-3 Omega-3 fatty acids also have been shown to inhibit bone loss and cartilage degradation in in vitro and animal studies.4-7 A meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 fatty acids supplements concluded that supplementation for 3–4 months significantly addresses joint health issues.1 C-reactive protein (CRP) is an inflammatory marker found in the blood, the levels of which rise in response to the inflammatory response process. Studies show that the higher the omega-3 levels in the blood of healthy individuals, the lower the CRP concentration.8 Supplementation with EPA and DHA has been shown in some, although not all, studies to decrease CRP levels as well as other biomarkers of inflammation in the blood.

9-12 Published clinical trials and case studies also demonstrate the important role of EPA/DHA in supporting the health of the cardiovascular, immune, and nervous systems including mood.12-16 The US Food and Drug Administration has determined that “supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”

Blueberries, raspberries, and black grapes
Blueberries, raspberries, and black grapes

Resveratrol

Resveratrol has anti-inflammatory properties and has been shown to blood indices of oxidative and inflammatory stress.46 Like curcumin, resveratrol decreases inflammatory cytokines such as interleukin-6 (IL-6) and cyclooxygenase-2 (COX-2) by inhibiting NF-KappaB signaling.43 Results from human trials confirming resveratrol’s clinical benefits are beginning to emerge.44-45

A double blind placebo controlled trial published in 2011 randomized two groups (10 each) of normal-weight healthy subjects to placebo or a standardized Polygonum cuspidatum extract containing 40 mg resveratrol daily for six weeks. Blood indices of oxidative and inflammatory stress were measured and resveratrol was found to induce significant reductions in reactive oxygen species generation, NF-kappaB binding, and numerous pro-inflammatory markers including TNF-alpha, IL-6, and C-reactive protein compared with the baseline and the placebo.46

Resveratrol, like curcumin, significantly decreases sensitivity to pain in animal studies.30-37 By decreasing pro-inflammatory cytokines, resveratrol significantly reduces pain behavior in rodents with disc-related pain.38 Signaling pathways in various types of joint cells can malfunction during aging, causing joint destruction and pain. When used together, resveratrol and curcumin have been shown to work synergistically to target multiple cellular signaling pathways in joint cells, effectively decreasing inflammation without adverse systemic effects.22 Resveratrol alone suppressed inflammation and destruction of inflamed joint cells in vitro.39

Sliced turmeric root and powder
Sliced turmeric root and powder

Curcumin

The principal component of the spice turmeric, has been used for its anti-inflammatory properties in India and China for centuries. Curcumin exerts its anti-inflammatory effects via a number of diverse mechanisms involving cell signaling molecules known as transcription factors (such as nuclear factor KappaB (NF-KappaB)), inflammatory cytokines (such as tumor necrosis factor (TNF) and interleukin 6 (IL-6)) and enzymes (such as cyclooxygenase 2 (COX-2)).

19 Different environmental stimuli activate nuclear factor KappaB (NF-KappaB): chemical, physical, mechanical, and psychological stress; environmental pollutants; high glucose; ultraviolet radiation; cigarette smoke; most inflammatory cytokines; and other disease-causing factors all activate NF-KappaB.17 Curcumin is a potent suppressor of NF-KappaB and has been shown to decrease NF-KappaB in humans when taken as a supplement. 20-21 Because of its effects on NF-KappaB, Curcumin is a powerful suppressor of COX-2, the key enzyme in the formation of mediators in the inflammatory response.23 Due to its anti-inflammatory activity, curcumin demonstrates beneficial effects on muscle regeneration after the effects of downhill running.24-25 Curcumin added to the diet hastens recovery of running performance in mice. Curcumin ameliorates pain sensitivity via mechanisms that are likely independent of its anti-inflammatory activity according to a number of animal studies.26-30

Epimedium plant leaves
Epimedium plant leaves

Icariin

Icariin is the main active flavonoid from the herb known as Epimedium. Species of Epimedium have been widely used for a number of inflammatory response conditions in traditional Chinese medicine and other Asian systems of medicine. The anti-inflammatory and antioxidant properties of icariin have recently attracted a new wave of scientific interest.

48 Icariin has been shown to protect DNA, nerve cells, and stem cells against free radical-induced damage in vitro.48-49, 51 Like resveratrol and curcumin, icariin appears to exert its anti-inflammatory effects via inhibition of NF-KappaB.50 In recent studies, icariin significantly decreased lung inflammation in mice by inhibiting a number of inflammatory compounds in mice such as tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), cycloxygenase-2 (COX-2), prostaglandin E2 (PGE(2)), nitric oxide (NO) as well as NF-kappaB activation.50,52 In another in vitro study icariin partially reversed markers of inflammation in cartilage cells from mice.47

References

  1. Goldberg RJ, Katz J. (opens in new tab) A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007 May;129(1-2):210-23.
  2. Maroon JC, Bost JW. (opens in new tab) Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31.
  3. Fontani G, Suman AL, Migliorini S, Corradeschi, Ceccarelli I, Aloisi A, Carli G. Administration of Omega-3 Fatty Acids Reduces Positive Tender Point Count in Chronic Musculoskeletal Pain Patients. Journal of Complementary and Integrative Medicine. 2010 Jan;7(1):Article 35.
  4. Maggio M, Artoni A, Lauretani F, Borghi L, Nouvenne A, Valenti G, Ceda GP. (opens in new tab) The impact of omega-3 fatty acids on osteoporosis. Curr Pharm Des. 2009;15(36):4157-64
  5. Curtis CL, Hughes CE, Flannery CR, Little CB, Harwood JL, Caterson B. (opens in new tab) n-3 fatty acids specifically modulate catabolic factors involved in articular cartilage degradation. J Biol Chem. 2000 Jan 14;275(2):721-4.
  6. Zainal Z, Longman AJ, Hurst S, Duggan K, Caterson B, Hughes CE, Harwood JL. (opens in new tab) Relative efficacies of omega-3 polyunsaturated fatty acids in reducing expression of key proteins in a model system for studying osteoarthritis. Osteoarthritis Cartilage. 2009 Jul;17(7):896-905.
  7. Wann AK, Mistry J, Blain EJ, Michael-Titus AT, Knight MM. (opens in new tab) Eicosapentaenoic acid and docosahexaenoic acid reduce interleukin-1ß-mediated cartilage degradation. Arthritis Res Ther. 2010;12(6):R207.
  8. Micallef MA, Munro IA, Garg ML. (opens in new tab) An inverse relationship between plasma n-3 fatty acids and C-reactive protein in healthy individuals. Eur J Clin Nutr. 2009 Sep;63(9):1154-6.
  9. Bloomer RJ, Larson DE, Fisher-Wellman KH, Galpin AJ, Schilling BK. (opens in new tab) Effect of eicosapentaenoic and docosahexaenoic acid on resting and exercise-induced inflammatory and oxidative stress biomarkers: a randomized, placebo controlled, cross-over study. Lipids Health Dis. 2009 Aug 19;8:36.
  10. Skulas-Ray AC, Kris-Etherton PM, Harris WS, Vanden Heuvel JP, Wagner PR, West SG. (opens in new tab) Dose-response effects of omega-3 fatty acids on triglycerides, inflammation, and endothelial function in healthy persons with moderate hypertriglyceridemia. Am J Clin Nutr. 2011 Feb;93(2):243-52.
  11. Myhrstad MC, Retterstøl K, Telle-Hansen VH, Ottestad I, Halvorsen B, Holven KB, Ulven SM (opens in new tab). Effect of marine n-3 fatty acids on circulating inflammatory markers in healthy subjects and subjects with cardiovascular risk factors. Inflamm Res. 2011 Apr;60(4):309-19.
  12. Ebrahimi M, Ghayour-Mobarhan M, Rezaiean S, Hoseini M, Parizade SM, Farhoudi F, Hosseininezhad SJ, Tavallaei S, Vejdani A, Azimi-Nezhad M, Shakeri MT, Rad MA, Mobarra N, Kazemi-Bajestani SM, Ferns GA. (opens in new tab) Omega-3 fatty acid supplements improve the cardiovascular risk profile of subjects with metabolic syndrome, including markers of inflammation and auto-immunity. Acta Cardiol. 2009 Jun;64(3):321-7.
  13. Ko GD, Nowacki NB, Arseneau L, Eitel M, Hum A. (opens in new tab) Omega-3 fatty acids for neuropathic pain: case series. Clin J Pain. 2010 Feb;26(2):168-72. PubMed PMID: 20090445.
  14. Monahan KD, Wilson TE, Ray CA. (opens in new tab) Omega-3 fatty acid supplementation augments sympathetic nerve activity responses to physiological stressors in humans. Hypertension. 2004 Nov;44(5):732-8.
  15. Lin PY, Su KP. (opens in new tab) A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry. 2007 Jul;68(7):1056-61.
  16. James M, Proudman S, Cleland L. (opens in new tab) Fish oil and rheumatoid arthritis: past, present and future. Proc Nutr Soc. 2010 Aug;69(3):316-23.
  17. Aggarwal BB, Harikumar KB. (opens in new tab) Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol. 2009 Jan;41(1):40-59.
  18. Deodhar SD, Sethi R, Srimal RC. (opens in new tab) Preliminary study on antirheumatic activity of curcumin. Indian J Med Res 1980;71:632-34.
  19. Zhou H, Beevers CS, Huang S. (opens in new tab) The targets of curcumin. Curr Drug Targets. 2011 Mar 1;12(3):332-47. Review.
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  21. Dhillon N, Aggarwal BB, Newman RA, Wolff RA, Kunnumakkara AB, Abbruzzese JL, Ng CS, Badmaev V, Kurzrock R. (opens in new tab) Phase II trial of curcumin in patients with advanced pancreatic cancer. Clin Cancer Res. 2008 Jul 15;14(14):4491-9.
  22. Shakibaei M, Mobasheri A, Buhrmann C. (opens in new tab) Curcumin synergizes with resveratrol to stimulate the MAPK signaling pathway in human articular chondrocytes in vitro. Genes Nutr. 2011 May;6(2):171-9.
  23. Kang G, Kong PJ, Yuh YJ, Lim SY, Yim SV, Chun W, Kim SS. (opens in new tab) Curcumin suppresses lipopolysaccharide-induced cyclooxygenase-2 expression by inhibiting activator protein 1 and nuclear factor kappaB bindings in BV2 microglial cells. J Pharm Sci 94: 325–328, 2004.
  24. Davis JM, Murphy EA, Carmichael MD, Zielinski MR, Groschwitz CM, Brown AS, Gangemi JD, Ghaffar A, Mayer EP. (opens in new tab) Curcumin effects on inflammation and performance recovery following eccentric exercise-induced muscle damage. Am J Physiol Regul Integr Comp Physiol. 2007 Jun;292(6):R2168-73.
  25. Thaloor D, Miller KJ, Gephart J, Mitchell PO, Pavlath GK. (opens in new tab) Systemic administration of the NF-kappaB inhibitor curcumin stimulates muscle regeneration after traumatic injury. Am J Physiol. 1999 Aug;277(2 Pt 1):C320-9.
  26. Yeon KY, Kim SA, Kim YH, Lee MK, Ahn DK, Kim HJ, Kim JS, Jung SJ, Oh SB. (opens in new tab) Curcumin produces an antihyperalgesic effect via antagonism of TRPV1. J Dent Res. 2010 Feb;89(2):170-4.
  27. Mittal N, Joshi R, Hota D, Chakrabarti A. (opens in new tab) Evaluation of antihyperalgesic effect of curcumin on formalin-induced orofacial pain in rat. Phytother Res. 2009 Apr;23(4):507-12.
  28. Sharma S, Kulkarni SK, Agrewala JN, Chopra K. (opens in new tab) Curcumin attenuates thermal hyperalgesia in a diabetic mouse model of neuropathic pain. Eur J Pharmacol. 2006 May 1;536(3):256-61.
  29. Tajik H, Tamaddonfard E, Hamzeh-Gooshchi N. (opens in new tab) The effect of curcumin (active substance of turmeric) on the acetic acid-induced visceral nociception in rats. Pak J Biol Sci. 2008 Jan 15;11(2):312-4.
  30. Sharma S, Chopra K, Kulkarni SK. (opens in new tab) Effect of insulin and its combination with resveratrol or curcumin in attenuation of diabetic neuropathic pain participation of nitric oxide and TNF-alpha. Phytother Res. 2007 Mar;21(3):278-83.
  31. Pham-Marcou TA, Beloeil H, Sun X, Gentili M, Yaici D, Benoit G, Benhamou D, Mazoit JX. (opens in new tab) Antinociceptive effect of resveratrol in carrageenan-evoked hyperalgesia in rats: prolonged effect related to COX-2 expression impairment. Pain. 2008 Nov 30;140(2):274-83. Epub 2008 Sep 23.
  32. Sharma S, Kulkarni SK, Chopra K. (opens in new tab) Effect of resveratrol, a polyphenolic phytoalexin, on thermal hyperalgesia in a mouse model of diabetic neuropathic pain. Fundam Clin Pharmacol. 2007 Feb;21(1):89-94.
  33. Sharma S, Chopra K, Kulkarni SK. (opens in new tab) Effect of insulin and its combination with resveratrol or curcumin in attenuation of diabetic neuropathic pain: participation of nitric oxide and TNF-alpha. Phytother Res. 2007 Mar;21(3):278-83.
  34. Granados-Soto V, Argüelles CF, Ortiz MI. (opens in new tab) The peripheral antinociceptive effect of resveratrol is associated with activation of potassium channels. Neuropharmacology. 2002 Oct;43(5):917-23.
  35. Torres-López JE, Ortiz MI, Castañeda-Hernández G, Alonso-López R, Asomoza-Espinosa R, Granados-Soto V. (opens in new tab) Comparison of the antinociceptive effect of celecoxib, diclofenac and resveratrol in the formalin test. Life Sci. 2002 Feb 22;70(14):1669-76.
  36. Falchi M, Bertelli A, Galazzo R, Viganò P, Dib B. (opens in new tab) Central antalgic activity of resveratrol. Arch Ital Biol. 2010 Dec;148(4):389-96.
  37. Utreras E, Terse A, Keller J, Iadarola MJ, Kulkarni AB. (opens in new tab) Resveratrol inhibits Cdk5 activity through regulation of p35 expression. Mol Pain. 2011 Jul 7;7:49.
  38. Wuertz K, Quero L, Sekiguchi M, Klawitter M, Nerlich A, Konno S, Kikuchi S, Boos N. (opens in new tab) The red wine polyphenol resveratrol shows promising potential for the treatment of nucleus pulposus mediated pain in vitro and in vivo. Spine (Phila Pa 1976). 2011 May 14.
  39. Shakibaei M, Csaki C, Nebrich S, Mobasheri A. (opens in new tab) Resveratrol suppresses interleukin-1beta-induced inflammatory signaling and apoptosis in human articular chondrocytes: potential for use as a novel nutraceutical for the treatment of osteoarthritis. Biochem Pharmacol. 2008 Dec 1;76(11):1426-39.
  40. Baur JA, Sinclair DA. (opens in new tab) Therapeutic potential of resveratrol: the in vivo evidence. Nat Rev Drug Discov. 2006 Jun;5(6):493-506. Epub 2006 May 26.
  41. Sharma RA, Steward WP, Gescher AJ. (opens in new tab) Pharmacokinetics and pharmacodynamics of curcumin. Adv Exp Med Biol. 2007;595:453-70.
  42. Hsu CH, Cheng AL. (opens in new tab) Clinical studies with curcumin. Adv Exp Med Biol. 2007;595:471-80.
  43. Gonzales AM, Orlando RA. (opens in new tab) Curcumin and resveratrol inhibit nuclear factor-kappaB-mediated cytokine expression in adipocytes. Nutr Metab (Lond). 2008 Jun 12;5:17.
  44. Vang O, Ahmad N, Baile CA, Baur JA, Brown K, Csiszar A, Das DK, Delmas D, Gottfried C, Lin HY, Ma QY, Mukhopadhyay P, Nalini N, Pezzuto JM, Richard T, Shukla Y, Surh YJ, Szekeres T, Szkudelski T, Walle T, Wu JM. (opens in new tab) What is new for an old molecule? Systematic review and recommendations on the use of resveratrol. PLoS One. 2011;6(6):e19881.
  45. Patel KR, Scott E, Brown VA, Gescher AJ, Steward WP, Brown K. (opens in new tab) Clinical trials of resveratrol. Ann N Y Acad Sci. 2011 Jan;1215:161-9.
  46. Ghanim H, Sia CL, Abuaysheh S, Korzeniewski K, Patnaik P, Marumganti A, Chaudhuri A, Dandona P. (opens in new tab) An antiinflammatory and reactive oxygen species suppressive effects of an extract of Polygonum cuspidatum containing resveratrol. J Clin Endocrinol Metab. 2010 Sep;95(9):E1-8.
  47. Liu MH, Sun JS, Tsai SW, Sheu SY, Chen MH. (opens in new tab) Icariin protects murine chondrocytes from lipopolysaccharide-induced inflammatory responses and extracellular matrix degradation. Nutr Res. 2010 Jan;30(1):57-65.
  48. Zhao F, Tang YZ, Liu ZQ. (opens in new tab) Protective effect of icariin on DNA against radical-induced oxidative damage. J Pharm Pharmacol. 2007 Dec;59(12):1729-32.
  49. Wo YB, Zhu DY, Hu Y, Wang ZQ, Liu J, Lou YJ. (opens in new tab) Reactive oxygen species involved in prenylflavonoids, icariin and icaritin, initiating cardiac differentiation of mouse embryonic stem cells. J Cell Biochem. 2008 Apr 1;103(5):1536-50.
  50. Xu CQ, Liu BJ, Wu JF, Xu YC, Duan XH, Cao YX, Dong JC. (opens in new tab) Icariin attenuates LPS-induced acute inflammatory responses: involvement of PI3K/Akt and NF-kappaB signaling pathway. Eur J Pharmacol. 2010 Sep 10;642(1-3):146-53.
  51. Zhang L, Huang S, Chen Y, Wang Z, Li E, Xu Y. Icariin (opens in new tab) Inhibits Hydrogen Peroxide-Mediated Cytotoxicity by Up-regulating Sirtuin Type 1-Dependent Catalase and Peroxiredoxin. Basic Clin Pharmacol Toxicol. 2010 Aug 19.
  52. Wu JF, Dong JC, Xu CQ. (opens in new tab) [Effects of icariin on inflammation model stimulated by lipopolysaccharide in vitro and in vivo]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009 Apr;29(4):330-4.

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