CHAPTER 9

Osteoarthritis

More than 52.5 million Americans have firsthand experience with osteoarthritis. Count in the bum knees, “tennis elbows,” and other crippling cartilage injuries sustained by professional athletes, weekend wannabes, and accident victims, and we have as many as eighty million sufferers in the United States alone. Just about everyone knows something about arthritis. Except what causes it and how to get rid of it.

Osteoarthritis Myths

It’s a myth, for instance, that osteoarthritis (OA) is caused by the “wear and tear” of old age and that everyone who lives long enough will be affected sooner or later. Although roughly 80 percent of Americans over the age of fifty suffer from some degree of osteoarthritis, 20 percent remain unscathed, a fact that raises serious questions about inevitability. If “everyone” sooner or later will—to quote a popular advertisement—“eventually feel the effects of a lifetime of use”—every senior citizen would be hobbled by arthritis. This is obviously not the case. Nor does the “wear and tear” hypothesis fit the fact that women are more prone to arthritis than men. Yes, women live longer than men, but osteoarthritis strikes them in larger numbers at every age.

The “lifetime-of-use” theory makes sense when cartilage cushions large weight-bearing joints such as the knee and hip joints and especially when people are overweight or obese. But it fails to explain why another popular spot for the disease is the fingers, which, though they may experience strain, are not called upon to bear weight at all.

Finally, if long-term wear and tear is the culprit, then why are increasing numbers of thirty- and forty-year-olds experiencing crippling pain? Surely, they are not moving their joints fast and furiously in double time. If anything, most of them work sedentary desk jobs.

The wear-and-tear theory does fit the manifestations of secondary osteoarthritis, the type caused by athletic injury, trauma, accident, or repetitive motion. The pitcher who throws a baseball over and over again is susceptible, as is a jackhammer operator whose shoulders take a beating from the rattling, vibrating device day in and day out. Primary osteoarthritis, in contrast, does not have such a clear-cut effect.

Skeletal evidence proves that arthritic degeneration has plagued humankind since the Stone Age. Egyptian mummies, Anasazi remains, and Roman baths all testify to ancient pain and suffering. Whales, birds, amphibians, and reptiles also come down with arthritis, and the dinosaurs had it two hundred million years ago. Though many researchers think this evidence suggests the disease is an inevitable part of aging, it only proves that arthritis has been around for ages.

However, we need only look at the bones of healthy primitive people to see that strong, flexible, straight bodies are our birthright. In the 1930s, Dr. Weston A. Price, DDS, traveled to isolated parts of the globe to study the health of populations untouched by Western civilization. The groups he visited included sequestered villages in Switzerland, Gaelic communities in the Outer Hebrides, indigenous peoples of North and South America, Melanesian and Polynesian South Sea Islanders, African tribes, Australian Aborigines, and New Zealand Maori. Wherever he went, he found people of all ages who were remarkably free of dental cavities, osteoarthritis, and other degenerative diseases.

Dr. Price’s findings make it clear that it is time to put to rest the wear-and-tear theory of arthritis. The problem is not old age but the fact that cartilage is breaking down faster than it is built up. The question is why, and the answer requires a revolution in our thinking about arthritis and an open mind to the ancestral wisdom of eating plenty of broth and other cartilage-rich foods.

What Is Osteoarthritis?

The name osteoarthritis—from the Greek words osteo for bone, arthro for joint, and itis for inflammation—suggests osteoarthritis is inflammation of the bones and joints. More accurately, the disease is marked by the quantitative and qualitative destruction of the articular cartilage in the joints within the hands and knees. Because inflammation is not always present, many doctors prefer to call OA degenerative joint disease.

Figure 6: This illustration shows the progression of osteoarthritis from a normal, healthy joint (left) to the thinning of cartilage (middle) to its destruction (right).

Articular cartilage—a term referring to the cartilage that wraps and protects the ends of bones—is crucial at movable joints such as the knee, elbow, or knuckles because it absorbs shock and reduces friction. When healthy articular cartilage is present, it continuously releases lubricating fluid to ensure that the joints glide slickly and smoothly against each other.

“Imagine rubbing together two perfectly flat, smooth, slightly wet ice cubes,” explains Jason Theodosakis, MD, of the Arizona College of Medicine in Tucson, in his bestseller The Arthritis Cure. “They glide across each other quickly and easily, never catching or slowing. Now imagine a surface that’s five to eight times more slippery than ice. That’s your cartilage, the material that makes it possible for the ends of your bones to slide smoothly and easily across each other. No manmade substance can compare to the low friction and shock absorbing properties of healthy cartilage.”

When the cartilage dries, thins, and cracks, we get the painful scraping of osteoarthritis with loss of joint motion, stiffness, swelling, and pain. Given that this unhappy chain of events occurs to people who do not subject their joints to excessive wear and tear or other trauma, as well as to only some of those who do, it is reasonable to conclude that a fundamental difference in the biochemistry of the cartilage exists that would account for the difference.

What Causes Osteoarthritis?

No one knows what initial event triggers the biochemical change that leads to osteoarthritis, but once articular cartilage begins to degenerate, the bones below harden and form unwanted bony spurs at the margins of the joints where tendons and ligaments are attached. Though pure cartilage has no blood vessels, blood vessels will invade cartilage once it starts to calcify into bone, contributing to the inflammation and pain of arthritis.

So where might the problem start? Most likely in the gelatinous matrix. People afflicted with osteoarthritis either do not produce enough of the protein sugars known as proteoglycans that are the building blocks of springy, plump, healthy cartilage or they do not produce them fast enough. People with OA are also prone to producing hunched-over little proteoglycans that hold water poorly because age or ill health have tipped the balance in favor of keratan sulfates instead of chondroitin sulfates (see the discussion on here). Finally, the body’s cartilage-chewing enzymes elastase and hyaluronase may develop an eating disorder that leads them to prematurely destroy cartilage.

What to Do?

The solution is as commonsensical as it is simple: Furnish the body with a food that contains the key biochemical components of healthy young cartilage. That food is old-fashioned bone broth. Soups and stews are staples in traditional cuisines all over the world and were regularly eaten by the healthy primitive people observed by Dr. Price. These people notably engaged in “nose to tail” eating, which meant no part of the animal went to waste. Cartilaginous cuts either were eaten directly or went into the stockpot. Today health experts are so out of touch that many believe there are few or even no dietary sources of cartilage. The University of Maryland Medical Center’s health information website flat-out states, “You can’t get cartilage from food. It’s available only in supplements.”

Consumed every day, bone broth supplies the components our bodies need to repair and rebuild cartilage and keep those gluttonous cartilage-eating enzymes under control. The twelfth-century Benedictine abbess Hildegard von Bingen recommended “frequent and adequate” portions of a broth made from ox feet for joint pain—and this remains good advice today.

Broth also helps us recover from the athletic injuries, trauma, or accidents that can lead to “trick knees” and other cases of secondary osteoarthritis. Standard therapies are hot packs, ultrasound, and manipulation by physical therapists, intended to increase the blood supply and speed the healing of the injured joint. But the bottom line is, if you flood a joint with blood lacking the nutrients needed to heal the injured tissues, the therapies will be mostly in vain. Because broth provides the necessary nutrients, it should form an essential part of any diet for athletes and for active people who want to remain vigorous into old age.

The Science

Broth is a staple in the diets of healthy people around the world and a probable reason they are free of osteoarthritis. Unfortunately, scientists have not studied the healing power of broth for arthritis prevention and reversal. Yet indirect evidence shows significant joint benefits from taking gelatin, cartilage, and collagen supplements and the building blocks glucosamine and chondroitin sulfate.

Surprisingly, Nathan R. Gotthoffer made only a single mention of “gouty arthritis” and wrote nothing at all about osteoarthritis, although his 1945 book Gelatin in Nutrition and Medicine exhaustively reports the science backing the use of gelatin for infectious and hemorrhagic diseases, muscular dystrophy, diabetes, and other diseases and disorders. Given the passion and thoroughness with which he researched this subject between 1927 and 1945, it’s likely no early studies exist.

According to the 2007 textbook Gelatine Handbook, German researchers took up the study of collagen hydrolysate for osteoarthritis in the 1970s. Collagen hydrolysate—a form of gelatin that’s been “conditioned” through a process known as enzymatic hydrolysis—is readily soluble in water. It is thus easy to stir into hot or cold food or beverages at home or mixed smoothly into products during food manufacture. Unlike the other widely available commercial proteins of casein, whey and soy, collagen hydrolysate does not become bitter from hydrolysis. This made it a useful and potentially very profitable product, and by the 1980s there were studies showing its efficacy.

In 1982, a report by B. Goetz appeared in the German medical journal Aerztliche Praxis. Sixty patients ages eight to thirty-three afflicted with youthful chondropathia patellae (arthritic knees) were tested after using collagen hydrolysate for one month, two months, and three months. At the end of three months, 75 percent were free of pain and cartilage regeneration had occurred in 80 percent of these cases.

In 1989, Drs. Klaus Seeligmuller and H. K. Happel of Bonn, Germany, reported on 356 patients suffering from arthritis of the knees, hips, and spine over a period of three to twelve months in the journal Therapiewoche. They measured “good” or “very good” results after using collagen hydrolysate with an astonishing 99.2 percent of the patients, with the strongest effect on knee and finger joints.

“ Knee Injury

By 1994 my knee problems had increased to where the discomfort kept me from riding a bike even a few feet. Looking at both knees through an arthroscope, you could see the usual cartilage covering was gone and the bare bone exposed. My orthopedic surgeon did some “housecleaning,” by which I mean he trimmed the unstable articular cartilage that was about to fall off around the edges of the exposed bone. The hope was the body’s healing response would result in a layer of scar tissue. While that’s a poor substitute for cartilage, it is better than nothing. My symptoms improved, but I always had fluid in the knee joints, indicating they were not as well as I could have hoped. Then about two years ago my knee symptoms started improving further and instead of always having fluid I now seldom have it.

When I asked the surgeon if I should thank him for this unexpected recent improvement, he said not at all. He said what he did could at best temporarily lessen symptoms and delay the need for artificial knee joints by months or a few years. What, then, might have caused the change? One of my farm activities is raising chickens on pasture, processing, and direct-marketing them. For years we gave away the chicken feet for free, but two years ago we began making very thick chicken foot broth for ourselves and adding this to all our soups and stews. Our broth consumption also greatly increased when we began marketing some of our pastured cows as ground beef, thus keeping most of the skeleton for ourselves.

I am physically active most all day every day caring for 470 acres with cattle herd, sheep flock, laying hens, and the few broilers for our extended family by myself. I heat two homes and one large farm building entirely with the wood I cut and haul. I have essentially no knee symptoms. I do such things as jump over the side of a three-quarter-ton truck to the ground below without bother but then lecture myself to be thankful for how well the knees are doing and not flaunt it by such abuse.

—Charles Henkel, Norfolk, Nebraska ”

In 1991, Milan Adam, DSci, of Prague’s Institute of Rheumatism Research, also published positive results in Therapiewoche. His randomized double-blind study on eighty-one patients suffering from OA showed a 50 percent reduction in pain for patients treated with collagen hydrolysate. The study led to patents for collagen hydrolysate in both Europe and the United States.

Since then, there have been at least nine clinical trials with more than two thousand patients afflicted with age- and activity-related OA. Most of the researchers reported that improvement of OA occurs gradually over a period of months of faithfully taking a daily dose of 10 grams of collagen hydrolysate. Given the propensity of arthritis sufferers to drop out before results could reasonably be expected to occur, the researchers counseled patients to be patient. Generally patients noted benefits to hair, nails, and skin ahead of experiencing improvement to their OA. Anecdotally, people report much the same from consuming two or three mugs of bone broth per day.

Over the years, sports physiologists have performed most of the collagen hydrolysate studies, including Dr. Friedhelm Beuker of the Institute for Sports Sciences at the University of Dusseldorf in Germany; Dr. Klaus Seeligmuller, a specialist in orthopedics, sports medicine, and physical therapy in Bonn, Germany; and James M. Rippe, MD, of the Rippe Lifestyle Institute in Shrewsbury, Massachusetts. In 2008, Kristine L. Clark, PhD, RD, a specialist in sports nutrition at Penn State, investigated the use of collagen hydrolysate to treat joint pain in athletes with no evidence of joint disease. She, too, announced significant improvement.

Collagen hydrolysate received its biggest boost in 2000 when Roland Moskowitz, MD, of Case Western Reserve University, studied the healing power of collagen hydrolysate at twenty medical centers in the United States, Great Britain, and Germany. Best known for his research linking OA to a defective collagen gene, Dr. Moskowitz’s six-month study showed a decrease in pain, increase in physical function, and increase in overall patient satisfaction. The best response came from those who’d been suffering the most severe symptoms. Interestingly, the greatest success occurred with Germans, not Brits or Americans, who dropped out of the study at the rates of 37 percent and 42 percent, respectively.

Even so, bad news has come in for collagen hydrolysate supporters. In 2012, J. P. Van Vijven and colleagues at the Erasmus University Medical Center Rotterdam, the Netherlands, examined eight studies on OA using gelatin, undenatured collagen, and collagen hydrolysate and reported that “the overall quality of evidence was moderate to very low,” and concluded there was insufficient evidence to recommend them in daily practice.

The biggest beneficiary of the studies from the 1980s and 1990s was probably Knox Gelatin, which introduced its NutraJoint product with great fanfare. Not long after, in 1997, the editors of the Tufts University Health and Nutrition Letter advised consumers not to buy NutraJoint or similar supplements because the idea that gelatin can contribute to the building of strong cartilage and bones “is a theory that has yet to be investigated.” As for the theory itself, they sniffed that it “sounds tidy—rather along the lines of ‘you are what you eat.’ ” In fact, collagen does seem to build collagen and cartilage, but cartilage may do it even better. Bone broth, which contains both, may do it best of all.

Cartilage Therapy

Dr. John F. Prudden, MD, DSci (1920–1998), is known as the “father of cartilage therapy.” Although his first studies involved cartilage injections, he subsequently worked with oral doses of 9 grams a day of a whole food–based bovine tracheal cartilage supplement first known as Catrix and later as VitaCarte. (For an up-to-date list of products that would have met Dr. Prudden’s quality standards, visit our website, www.nourishingbroth.com.)

In a major article published in the summer 1974 issue of Seminars in Arthritis and Rheumatism, Dr. Prudden detailed the cases of twenty-eight people suffering from pain and disability caused by OA. They’d tried nearly every drug in the anti-arthritis pharmacopoeia, but nothing had helped much or for long. The patients were, in Dr. Prudden’s words, “desperate over their pain and disability, and because of this, willing to subject themselves to experimental therapy.”

Over a period of three to eight weeks, Dr. Prudden and his team administered subcutaneous injections of 50 cc of bovine cartilage daily to each of the participants. By the end of the study, nineteen of the twenty-eight were in “excellent” condition with a complete elimination of pain and discomfort. Six were in “good” condition with a marked decrease in pain and an increase in mobility. Two experienced only minor benefits and one showed no discernible effect. No toxicity was reported, and no toxicity was shown through the batteries of laboratory tests. These included complete blood count (CBC), urine analyses, and scores of other standard predictive and assessment indices. Most remarkably, the relief lasted from a minimum of six weeks to more than a year due to ongoing absorption of the injected cartilage under the skin. Cartilage injections obviously differ from consuming cartilage-rich broth, although key components survive the digestive process.

Thrilled by this success, Dr. Prudden tested the effectiveness of cartilage pills on seven hundred people, reporting 49 percent with “excellent” results and 26 percent “good,” for a total improvement rate of 85 percent. When the patients stopped taking the pills, the average length of remission was six to eight weeks. While this was a much shorter time than the results achieved by injection, it was easily remedied with an ongoing maintenance dose of pills.

Dr. Prudden considered the injectable form more effective for severe arthritis because it bypassed the gut, where digestive enzymes dismantle and destroy growth factor proteins. That problem, of course, also occurs with the digestion of cartilage-rich bone broth. Injected, the growth factors in cartilage are absorbed into the bloodstream and used. “Growth factors are ideal for someone who needs to grow more tissue, such as someone with osteoarthritis,” explained Dr. Prudden, “but they’re not for someone with a malignancy, which is why we prefer the pills for people with cancer.”

Since Dr. Prudden published his findings in 1974, other researchers have confirmed his findings in long-term studies. A ten-year study conducted in the 1970s and 1980s in Eastern Europe was published in Seminars in Arthritis and Rheumatism in 1987. Dr. Václav Rejholec of Charles University in Prague collected data on arthritis sufferers and reported that patients who took bovine tracheal cartilage supplements took an average of twenty sick days per year. Those who did not take cartilage saw their disease progress and pain increase as they stayed home from work more and more, culminating in a loss of 180 out of 250 working days by the tenth year. These patients used the standard NSAID drugs or placebos to fight pain and inflammation.

Dr. Rejholec concluded, “It is clear that any form of medication that is well tolerated and shown to be capable of influencing the natural history of OA either by slowing progression or by bringing about actual regression must be regarded as a major advance in the therapy for this condition. The implications in terms of relief of suffering, health care resources and socio-economic costs to the community are similarly far reaching.”

An earlier study of great interest to Dr. Prudden was published by Alfred Jay Bollet, MD, in the journal Arthritis and Rheumatism in 1968. It proved that cartilage extracts stimulate chondroitin sulfate synthesis. This component of cartilage matrix not only attracts the water needed for plump, healthy cartilage but also reduces excessive numbers of cartilage-chewing enzymes.

Cartilage Therapy in the Limelight

Dr. Prudden stayed out of the limelight while testing bovine tracheal cartilage in well-designed long-term studies. In contrast, during the same period, I. William Lane, PhD (1922–2011), began heavily promoting shark cartilage as a cure for osteoarthritis as well as cancer in his bestselling book Sharks Don’t Get Cancer.

Lane claimed the key curative agents in shark cartilage were proteins known as anti-angiogenesis factors, a term that refers to the inhibition of new blood vessel formation. Because normal, healthy cartilage has no blood vessels, all cartilage comes equipped with this protein factor. Shark skeletons have it and so do bovine tracheas, chicken sternums, kangaroo tails, and human joints.

Anti-angiogenesis factors would be helpful to people suffering from osteoarthritis because the initial degeneration and thinning of articular cartilage is followed by the invasion of blood vessels. Because healthy cartilage is avascular, blood vessels bring on further breakdown and pain. The problem with the theory is that anti-angiogenesis factors in oral supplements break down in the gut, just as they do in broth. That was the view not only of Dr. Prudden, but also of Judah Folkman, MD, of Children’s Hospital and Harvard Medical School, the discoverer of the anti-angiogenesis factor. Robert Langer, ScD, of the Massachusetts Institute of Technology, another expert in anti-angiogenesis, concurred. Despite the efforts of Prudden, Folkman, and Langer to put a stop to the claims, Lane persisted, and numerous websites today still sell products marketed with this untruth.

Furthermore, Lane built much of his case for shark cartilage as a cure for arthritis and cancer using studies that were actually done on bovine cartilage, including the work of Drs. Prudden and Rejholec. Research by Serge Orloff, MD, of Brugmann University Hospital in Brussels and the Executive General Secretary of the International League Against Rheumatism, did show dramatic results, but the study was on a single patient. A study by Jose A. Orcasita, MD, of the University of Miami School of Medicine, was on just six elderly patients and lasted only three weeks. A third, by Dr. Carlos Luis Alpizar, a gerontologist in Costa Rica, was on ten patients and also lasted three weeks.

Clearly Lane’s marketing was ahead of the science. This is not to say that shark cartilage couldn’t be useful. It has been valued for its medicinal properties ever since the ancient Chinese began singing the praises of shark fin soup. Dr. Prudden himself found that the cartilage of calves, sharks, teju lizards, and crocodiles all possessed similar healing properties. That said, shark cartilage has some distinct drawbacks, including the necessity of doses so high they cause nausea and lack of appetite, as well as a cost that can top one thousand dollars a month. There are also safety concerns about high calcium content. Shark cartilage is 20 to 22 percent calcium, whereas bovine cartilage is only 1 percent calcium. Taken at the full therapeutic dose of 70 grams a day, shark cartilage provides 14 grams of calcium, which is a whopping 14 times the RDA. The therapeutic dose of Dr. Prudden’s bovine cartilage was only 9 grams per day.

“ Hip Trouble

I have had very few health issues and take no medications, but around age fifty, I began having a lot of trouble with my hips. I experienced pain, difficulty walking, sciatica, etc. I tried many approaches, including muscle therapy and physical therapy, but nothing really helped until I committed to drinking a cup of bone broth every day. I started doing this and within a week, the pain was greatly reduced. My joints are also more flexible and I can now walk normally. I love to hike, so you can imagine how important this is to me! To say I’m thrilled is an understatement!

Interestingly enough, I already had known about the benefits of bone broth for arthritic pain, but didn’t commit until I met an older carpenter at one of our chapter meetings who told me that WAPF had saved his life. He was going to have to quit working because of the pain in his knee, but two months of drinking two cups of bone broth a day eliminated the pain. His story motivated me to finally get serious about bone broth.

—Nancy Eason, Fort Collins, Colorado ”

Other Cartilage Fractions

Studies on chicken sternal cartilage and chicken sternal collagen type II are sparse, but include a 2012 study published in the Journal of Agriculture and Food Chemistry by Alexander Schauss, PhD, and colleagues at AIBMR Life Sciences in Puyallup, Washington. This randomized, double-blind, placebo-controlled trial looked at eighty patients and reported their patented product BioCell to be well tolerated, well absorbed, and effective in managing OA-associated symptoms.

Despite success with whole food collagen and cartilage supplements over the past forty years, most researchers have chosen to focus on fractions of cartilage, particularly glucosamine sulfate and chondroitin sulfate. As discussed in chapter 7, glucosamine is a naturally occurring amino sugar that is a major constituent of proteoglycans and glycosaminoglycans (GAGs), the water-loving molecules in cartilage. Most supplements on the market come from crab, lobster, and shrimp cells.

Chondroitin sulfate is a large, gel-forming molecule that helps keep cartilage cushy and able to cope with compression. Supplements come from extracts taken from cow, pig, fish, or bird cartilage.

Glucosamine and chondroitin supplements are some of the most popular supplements ever sold at health food stores and drugstores. Although the initial fad was set off by the bestselling book The Arthritis Cure, first published in 1997, consumers would not continue to purchase these products if they obtained no benefits.

Side Effect Dangers

Even so, glucosamine and chondroitin sulfate have not lived up to the initial promise of a miracle pill capable of curing incurable osteoarthritis. To date, the studies have been inconsistent, inconclusive, and controversial, with the most reliable outcome being mild relief from pain. Although this would seem to be a rather unremarkable benefit, it makes it possible for patients to reduce their consumption of NSAIDs and other drugs, most of which come with a long list of unwanted side effects including stomach irritation, bleeding, and ulceration. High blood pressure, kidney problems, and liver damage are other possibilities. The longer the use, the higher the dose, the greater the risks.

The dangers of these over-the-counter drugs are far greater than most people imagine, and these “minor” arthritis drugs directly or indirectly kill between seven and ten thousand Americans each year and result in more than one hundred thousand hospitalizations.

Clearly glucosamine and chondroitin are worthwhile, even if all they can do is alleviate some of the pain of osteoarthritis and cut down on NSAID usage.

Other Studies and Trials

Findings that glucosamine and chondroitin can stop or even reverse disease progression are less consistent. The supplements appear to work better on mild osteoarthritis than severe forms, though well-documented cases of success with both exist. Overall the thousands of studies on glucosamine and chondroitin sulfate alone and in combination are inconsistent, contradictory, and confusing. The problems are many, and pertain to study design, data gathering, data analysis, too short duration, insufficient dosing, poor patient compliance, and uncontrolled co-medication and over-the-counter and prescription drugs. Industry-sponsored trials have also shown more pronounced differences between supplements and placebos than industry-independent trials. As a result, glucosamine and chondroitin products remain controversial. The usual conclusion to the studies is some variation of “Further investigations in larger cohorts of patients for longer time periods are needed to prove its usefulness as a symptom modifying drug in OA.”

The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) cost the American taxpayers fourteen million dollars and was supposed to put the questions to bed once and for all. Sponsored by the National Institutes of Health (NIH), this double-blind placebo-controlled study was conducted over a four-year period at sixteen sites across the United States and enrolled nearly sixteen hundred patients. The long and confusing results were rolled out in the New England Journal of Medicine in 2006. In brief, the researchers concluded the combo of glucosamine and chondroitin showed no significant difference compared to placebo, though a subset of patients with moderate to severe pain did see good results. In 2008, a twenty-four-month follow-up to GAIT again found patients on glucosamine and chondroitin who fared no better than those on a placebo. This follow-up study, however, was seriously flawed for many reasons, including patient dropout, a recurring pattern with glucosamine and chondroitin studies.

Although patient dropout complicates study outcomes, it reflects the real world, where patient adherence to arthritis medication and supplement protocols is notoriously low. As Tracey-Lea Laba, PhD, and colleagues from the University of Australia in Sydney explain, “The negative relative likelihood of NSAID continuation was mostly driven by the side effect profile. The predicted probability of continuing with glucosamine decreased with increasing out-of-pocket costs.”

Fraction Versus Whole

Why else might glucosamine not work as well as might be hoped? The deeper problem might be the inadequacy of fractionated supplements. In short, there’s more to cartilage than glucosamine alone.

Asked about The Arthritis Cure a year before his death, Dr. Prudden said glucosamine was an inferior remedy compared to whole cartilage extracts because the molecule was too small and too soluble to end up in the joints. “It doesn’t work as well because it gets gobbled up by the capillaries, goes into the blood stream and quickly out of the body via the kidney,” he explained. “In contrast, the whole cartilage molecule is large and breaks down slowly. The body’s lysozyme cleaves the large molecule. Nothing works as well.”

Dr. Prudden furthermore said he tested glucosamine, chondroitin, and collagen in his wound-healing experiments during the 1950s and 1960s and only whole cartilage—which of course we find in cartilage-rich broth—did the trick. “I would say that the restoration of broken down cartilage would require wound healing capacity,” he said, though he conceded that a diminishing inflammation and other symptoms through glucosamine or other supplements might, in some cases, improve conditions enough for the body to begin restoration on its own. In contrast to Father Technology’s laboratory-extracted fractions, he saw cartilage as “Mother Nature’s mixture, arrived at over an immense span of time.”

The question is, would cartilage-rich bone broth soup work even better, at least for disease prevention and overall health maintenance? Although interest in soup as a source of healing has languished since the advent of “quick fix” drugs and supplements, traditional wisdom holds it should be served at least daily and as the foundation of a real foods diet. Over the past fifteen years countless numbers of people have told us “broth is beautiful” and thanked us for encouraging them to get the stockpot out and the soup simmering. Those with severe symptoms might need to work with an alternative medical doctor or other health practitioner and give supplements a try as well. Any way we look at it, there’s plenty of evidence that contradicts the notion that the only way to heal osteoarthritis is, well, not at all.