What's a good supplement for joints and tendons?

Three tests for two tissues: what good has to mean before a name is given, and the shelf run through the scorecard

What's a good supplement for joints and tendons is a question that wants a name, and the honest page refuses to give one until it has given the scorecard, because good has to mean something checkable and the question names two tissues, which doubles the checking, so that a name offered without the scores is a guess dressed as advice. Good has three tests. The first is a lawful sentence: does the register of authorised health claims permit any sentence about the supplement and the tissue, since a permitted claim is one that a regulatory authority examined the evidence for and found sufficient, and a supplement with no sentence for a tissue is one for which no authority has been persuaded. The second is a trial: has the supplement been given in a randomised controlled trial to people with that tissue's problem, knee pain or tendinopathy, and measured against placebo on an outcome that matters, since testimonials, mechanism and animal work are not trials. The third is dose: does the amount on the label match the amount the trial used, since a result at 10g a day in a trial says nothing whatever about a capsule delivering 500mg, and the shelf's commonest move is to borrow a powder's trial for a capsule's label. Three tests, two tissues, six scores for every candidate, and the shelf run through them looks like this. Vitamin C passes the sentence for joints, since it contributes to normal collagen formation for the normal function of cartilage, which is the only cartilage sentence any nutrient holds, and holds no tendon sentence, since the register searched for the word tendon returns nothing; it has no trial in either tissue above sufficiency, because once the collagen enzymes are saturated more vitamin C does nothing to them; so it scores one for joints, the sentence, and nothing for tendons, and a satsuma a day supplies the amount the sentence needs. Collagen passes the trial for both tissues, which is more than anything else on the shelf manages: for joints, the questionnaire trials at around 10g a day for twelve to twenty-four weeks in people with knee pain found a point or two less pain than placebo, and for tendons the protocol of 15g gelatin or collagen with vitamin C about an hour before loading raised a synthesis marker in healthy men and one small six-month trial of 2.5g beside calf strengthening improved Achilles tendinopathy more than placebo beside the same exercise; it fails the sentence for both, since no collagen claim is authorised for any tissue; and it passes the dose only as a powder, since the trial amounts are scoops and a capsule habit of 1 to 2g sits below them. So a powder collagen at trial doses scores two of three for each tissue and a capsule scores one for each, the trial it borrows. Glucosamine and chondroitin hold no sentence, failed their large independent trials in knee osteoarthritis and have no tendon trial, so they score nothing for either tissue, whatever the aisle says. Omega-3 holds sentences for the heart, brain and eyes and none for joints or tendons, with small mixed trials in inflammatory arthritis that do not transfer to an osteoarthritic knee or a tendinopathy, so it scores nothing here. Undenatured type II collagen passes small joint trials at 40mg a day, holds no sentence and has no tendon trial, so it scores one for joints. Turmeric, boswellia, MSM and the herbal shelf hold no sentences and have small, short or absent trials in either tissue. The scorecard, read across, has one candidate at two of three for both tissues and everything else at one or nothing, and that is the answer the question wanted, with its conditions attached.

The answer with its conditions, the thing that scores three of three, how to buy the two-of-three honestly, and the capsule on its true terms

The answer the scorecard gives is a powder collagen at the trial doses with vitamin C beside it, and the honest page attaches the conditions before anyone buys a tub. The first condition is the dose, which is the whole difference between two of three and one of three: around 10g a day for the joint result, taken daily for twelve to twenty-four weeks, which is the timescale on which the questionnaires moved; and 15g about an hour before a loading session for the tendon protocol, which is the timing the marker trial used, with the one outcome trial having run at 2.5g a day for six months beside calf strengthening. A reader who wants both results wants a powder of 10 to 15g a day, which is a scoop and a pound a day, not a capsule. The second condition is the vitamin C, which is the only claim-holder in the pairing and which the protocol included at around 50mg as the cofactor; a satsuma supplies it, a label at 12mg clears the threshold for the cartilage sentence, and neither is a dose. The third condition is the expectation, which the trials set: a point or two on a ten-point joint pain scale over months, a marker rise before loading and a modest advantage beside six months of calf work for the tendon, nothing structural on any scan, and nothing at all without the loading beside it. One protein with two attachments, both type 1 collagen adapting to load over months, is the frame on the tendons and ligaments supplements page. The thing that scores three of three for both tissues is not on the shelf, and the honest page gives it its place above the scorecard: progressive loading. For tendons it is the treatment, isometrics for pain and heavy slow resistance every second or third day through months of remodelling, ahead at twelve months of waiting and of every injection in the trials, which is the twelve-month column on the what really works page; for joints it is the first-line management of osteoarthritis in every guideline, quadriceps strength, moderate cyclic load and body weight, with cartilage composition rising on contrast MRI under moderate exercise; and it has the sentence, in the sense that every guideline writes it, the trials, and the dose, since the dose is the programme. Every supplement on the scorecard, including the one that scores two, sits beside the loading and not instead of it, and a reader who buys the two-of-three and skips the three-of-three has bought the adjunct and left the treatment, which is the commonest mistake on the whole shelf and the one the tendonitis question is answered against on the best supplement for tendonitis page. How to buy the two-of-three honestly is a short list: a plain hydrolysed collagen powder, bovine or marine, at a stated gram dose per scoop with a third-party assay, since the metals in the source are the long-term question; a vitamin C source, which is fruit; the loading programme written down first; and the three baselines, a pain score out of ten on one movement for the joint and the morning-after pain rule and a hop test for the tendon, taken before the first scoop so that the point or two, if it comes, is seen rather than imagined. The capsule is the habit that scores one, and it is sold on its true terms: two capsules, 1200mg hydrolysed type 1 marine collagen with 12mg vitamin C at 15% of its reference value plus zinc, 120 for £16.99 at 28p a day, lab tested and UK made, below the 10g joint dose and the 15g tendon dose, carrying vitamin C's collagen formation sentence for the normal function of cartilage and no joint or tendon claim of its own, a convenient daily amount of a protein with a borrowed trial and a passenger that holds the one lawful sentence, which is a fair description of most of the shelf and an honest one of this. What's a good supplement for joints and tendons: a powder collagen at the trial doses with vitamin C beside it, scoring two of three for both, taken beside the loading that scores three, with the capsule a one-of-three habit at 28p.

What to check on the label