LQ interview with Dr. Sarah Brewer

What puts the most pressure on our joints and how can we avoid this?

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Weight bearing and repetitive actions put the most stress on your joints. Jumping down from the cab of a lorry, for example, would subject your knee joints to impact forces as high as 12 times your body weight! Your weight bearing joints, such as the knees, survive these pressures due to the resilience of cartilage which can spring back into shape, and the cushioning effect of joint synovial fluid.

What is the best way to maintain joint health?

Gentle, regular exercise helps to maintain joint mobility. As well as strengthening muscles it boosts the flow of oxygen and nutrients to joint tissues – especially vital for cartilage which does not have a blood supply and must obtain its nutrients by diffusion. Exercise also helps to maintain the layer of lubricating synovial fluid over the articular surface. Obtaining sufficient building blocks to make new joint tissues is also key. The rate limiting step for production of new joint tissues is usually the slow production of glucosamine, so supplements that supply these are widely recommended. Glucosamine usually works especially well when combined with other nutrients needed for joint health or which have anti-inflammatory properties such as chondroitin, hydrolysed collagen, vitamins C and E, and ginger root extract. These are available as tablets, or can be taken in a liquid formulation such as LQ Joint Care.

Should we be maintaining joint health from a young age?

Just about everyone should take steps to look after their joints, especially if you are aged 40 or over, if you are overweight, or if osteoarthritis runs in your family. Those whose work or recreational activities involve repetitive movements, or which can lead to injury, should also take care. Athletes, for example, are very aware of their joints, and look after them, as both their performance and career depend on them.

Before joint pain becomes an issue, you may notice a creakiness in one or more joints, or feel the need to stretch your back every day. A joint may become less flexible than before, or can no longer be straightened fully. You may notice that your joints are swelling or changing shape, or that your hands and feet easily get cold and stiff. A joint may also start to ache, especially after exercise, and it may be uncomfortable to kneel. Once you start noticing these signs, it is vital to protect your joints and long term mobility.

As we get older, the cartilage, synovial fluid and bones that form our mobile joints start to show characteristic signs of wear and tear. This is particularly noticeable in articular cartilage, which is a unique tissue from the perspective of ageing. Cartilage has a very low turn-over, meaning that, unlike most other tissues, it is not continually broken down and replaced[i]. It therefore has to withstand years of use and abuse, although limited repair of age-related damage can occur.

Articular cartilage becomes increasingly soft and develops characteristic vertical cracks on its surface. This process, which is similar to a material fraying[ii], is known as fibrillation. It occurs when the sugar-protein molecules (proteoglycans) within the cartilage matrix become smaller and more irregular, and collagen proteins show increased amounts of cross-linking. At the same time, the amount of water present within the articular cartilage decreases. In effect, the cartilage starts to dry out. Together, these changes make the cartilage weaker and less flexible.

Synovial fluid also becomes thinner and less cushioning with age as the amount of chondroitin sulphate and hyaluronic acid it contains starts to fall[iii]. The level of chondroitin sulphate in your synovial fluid is highest between the ages of 20 and 30 years, for example, then progressively falls until it has approximately halved by the age of 70-80.[iv] As the level of these substances fall, less fluid is attracted into the joint and the total amount of synovial fluid reduces.

How does LQ Liquid Health Joint care work?

Supplements can help in several ways by:

providing building blocks for the production new joint components
Act as signals to switch on the repair of damaged tissues
Suppress inflammation
Inhibit enzymes that dissolve cartilage

Studies using cultured human cartilage cells have found, for example, that the level of 31 different proteins are altered by the addition of glucosamine or chondroitin, compared to non-treated controls.

- 35% were involved in biological signalling (telling cells what to do)
- 25% were involved in the synthesis of proteins such as collagen
- 15% were involved in antioxidant stress responses

LQ Liquid Health Joint Care combines key joint nutrients to help maintain and repair healthy joints: hydrolysed collagen, glucosamine, chondroitin, ginger root extract, vitamins C and E plus copper.

Do you feel it is important to include supplements within our diet?

Having analysed hundreds of diets I have not yet found anyone who gets all the nutrients they need from their food. Some are close, but intakes of minerals in particular, such as iron, magnesium, selenium and potassium are often low, as shown in National Diet and Nutrition Surveys. https://drsarahbrewer.com/some-people-do-need-vitamin-supplements

I personally do take supplements as recommended intakes are only designed to prevent deficiency diseases – they don’t necessarily provide the optimum amount for good health.

Do you prefer liquid or capsule form supplements?

It depends on the supplement I am taking. For herbal medicines I prefer tablets to tinctures. For multivitamins I currently like chewable ‘gummies’ as you might as well get some pleasure from taking your supplement! For hydrolysed collagen you can get a higher dose into a 50ml liquid supplement such as LQ Liquid Health Joint Care. It comes down to personal choice, however – it is best to take the supplement you find most convenient for you.

It is suggested that some people struggle to swallow capsules, is LQ Liquid Health a better option for those?

Swallowing tablets is a real issue for many people, with studies showing that 44% of people in the normal ageing population experiencing swallowing problems. A survey of people aged between 60 and 89 years reported that:

60% experienced difficulties swallowing tablets or capsules.
68% needed to crush a tablet or open the capsule to take the medicine.
69% did not take their medicines because they were too hard to swallow.

As this is the age group most likely to experience persistent joint problems, it’s important to have liquid formulations such as LQ Liquid Health Joint Care available for those who prefer to use them.

What is the benefit of taking a supplement in liquid form as opposed to a capsule?

Benefits can include:

Providing a higher level of nutrients in a single dose
An alternative to taking a handful of tablets
Rapid absorption – especially for older people with reduced levels of stomach acid and digestive enzymes
Pleasant taste (although this isn’t always the case!)

How do you manage a balanced diet and ensure you get all the relevant nutrients?

The official line is that you can get all the nutrients you need from your food. While this may be true in an ideal world, we live in the real world where people make food choices based on flavour, cost, availability, habit and personal preferences. We still haven’t hit the 5-a-day food target, for example.

The government’s own NDNS surveys show that significant numbers of people do not even get the minimum level of certain nutrients that is needed to prevent deficiency diseases such as iron-deficiency anaemia, osteoporosis.

Lack of nutrients can cause common symptoms such as tiredness, fatigue, dry skin, reduced immunity and may contribute to long term poor health. I firmly believe that most people will benefit from taking a carefully selected, good quality supplement that meets their individual needs. Everyone should be taking a vitamin D supplement during winter at the very least.

My free booklet Do You Need A MultiVitamin? is available via this link.

Do you have a lifestyle motto that you swear by?

Try everything at least once.

How do you recommend marathon runners care for their muscles and joints?

Seek individual advice from a sports nutritionist to ensure you obtain the right diet to support your training and event regime. A personalised program that includes glucosamine, chondroitin, hydrolysed collagen, hyaluronic acid, vitamins, minerals and selected extracts such as ginger root and/or turmeric is likely to pay long-term dividends. You can take different tablets to obtain these, or take a liquid formation that combines them in a drink such as LQ Liquid Health Joint Care.

It has been suggested that exercising intensely can put a lot of pressure on our joints, how can you avoid causing injury?

If you exercise intensely, it is important to seek advice from a sports physio and an exercise trainer to help minimise stress on your joints due to poor technique or over-training.

What exercises would you recommend to support joints?

For people who are experiencing age or activity related joint symptoms, low impact, aerobic exercises such as swimming, cycling and walking are most beneficial. You might try a progressive walking regime, starting with an amount you can tolerate well, say 10 minutes, and gradually increase to 30 to 60 minutes, 3 to 5 days per week. Avoid prolonged kneeling, squatting or walking more than 2 miles per day, however, which may have an adverse effect on joints. You should also avoid walking on rough or uneven ground.

As we get older our flexibility and mobility naturally decreases, do you have any tips for prevention/improvement?

Daily exercise helps to maintain a joint’s range of movement, even if this is limited, and helps to avoid muscle weakening and contractures. If you stop exercising you will quickly notice a decrease in muscle bulk.

Exercise helps to maintain a layer of synovial fluid over the surface of articular cartilage in a process known as weeping lubrication, which helps to protect cartilage. Muscle conditioning and aerobic exercises can significantly reduce symptoms in people with OA of the knee. People with OA who exercise regularly experience less stiffness and pain in their lower limbs than those who don’t[v].

In fact, exercises designed to strengthen the quadriceps muscles in the front of the thigh appear to be as effective in reducing symptoms of knee osteoarthritis as non-steroidal anti-inflammatory painkillers[vi].

For overweight people with osteoarthritis of the knee, the combination of losing body fat and increasing physical activity is more effective at improving pain and physical function than either approach alone.[vii]

In the Arthritis, Diet and Activity Promotion Trial (ADAPT) for example, which involved over 300 sedentary, overweight people with OA, those who combined exercise with a weight loss diet did significantly better than those using exercise or weight loss alone, or who just followed a healthier lifestyle. They reported less knee pain, an improved ability to climb stairs and were able to walk further during a 6-minute test period[viii].

You can use hot packs or cold packs to help reduce pain before and after exercise. If you find exercise triggers persistent joint pain, however, reduce the intensity of the activity or change to another form of exercise such as swimming.

Avoid exercising if a joint is inflamed or swollen, however, until symptoms have subsided.

What natural ingredients help ease joint pains/aches?

There is a surprisingly long list of natural substances that can help knee pain, from those that provide structural building blocks to those that have analgesic and anti-inflammatory actions. The ones I have found most beneficial in clinical and nutritional medicine practice are:

Glucosamine & chondroitin

Hydrolysed collagen

Hyaluronic acid

Ginger root extract

Krill oil

Turmeric

Rose hip extracts

Devil’s claw

Cherry extracts

I’ve reviewed what I believe are the best supplements for joint health here: https://drsarahbrewer.com/the-9-best-supplements-for-knee-pain

What supplements do you take?

I take quite a few and these have increased over the years as I’ve reviewed the evidence for their benefits. I currently take:

Alive! Women’s 50+ soft jell multi-vitamins

Healthspan Chondromax (glucosamine & chondroitin)

Opti-turmeric – for anti-inflammatory benefits

Super20 Pro (probiotic) – for digestive & immune health

Evening primrose oil – for skin-friendly essential fatty acids

Magnesium – for metabolism and anti-ageing benefits

Black garlic – for antioxidant and anti-ageing benefits

Globe artichoke – for liver and digestive health

Vitamin C 500mg – for antioxidant benefits

Vitamin D3 25mcg – for immune health and calcium metabolism

LQ Liquid Health Joint Care for additional joint support following a skiing accident in which I twisted my knee.

Is there anything you have completely eliminated from your daily diet?

I tend to follow a low sugar, low GI diet and now eat very little bread, white potatoes or pasta – instead I spiralise courgettes, carrots and sweet potato on which to put my home-made pasta sauces.

What other benefits does marine collagen have other than supporting joints?

There is excellent evidence for the use of hydrolysed marine collagen in boosting collagen production in skin and helping to prevent wrinkles. I’ve reviewed the evidence here: https://drsarahbrewer.com/can-hydrolysed-collagen-drinks-really-reduce-skin-wrinkles

[i] http://sageke.sciencemag.org/cgi/content/abstract/2004/29/pe31

[ii] http://www.ingentaconnect.com/content/klu/bgen/2002/00000003/00000005/05090807?crawler=true

[iii] http://www.springerlink.com/content/p523w9nx31ny8atl/

[iv] http://www.ncbi.nlm.nih.gov/pubmed/12209515

[v] https://www.ncbi.nlm.nih.gov/pubmed/15075418

[vi] https://www.ncbi.nlm.nih.gov/pubmed/18356618

[vii] https://www.ncbi.nlm.nih.gov/pubmed/9818662

[viii] https://www.ncbi.nlm.nih.gov/pubmed/15146420