Joint Supplements: The Good, the Bad, and the Useless

By Dr. David F. Davenport, DVM, MS, CNS,
Dr. Jim Blackford, DVM, MS, dACVS,
Dr. Michael R. Bishop, MD, PhD, FACOG
edited into layman's terms, and updated
by Terry Mercer, President, MD's Choice
© 1998 - 2017

The number of products claiming to help joint pain is growing rapidly over the last 30 years.  You can't avoid the advertisements claiming that this product or that one is some 'magic bullet' or 'miracle cures' or will 'eliminate joint problems' or 'cure arthritis,' or 'be a liquid joint replacement.'

Take a moment to step back and think, to ask questions, and do a little research. Although the following article is geared toward people and their specific joint related problems, the principles of nutrition are true for all mammals... people and our pets!

The basics doesn't need to be magic, just a band-aide, or some other temporary symptom masker.
First, understand that marketing and advertising claims of "It Works" can have two very different - and often opposed - meanings:

1. The most common type, especially on store shelves: Masks the problems, covers the symptoms, blocks the pain.  The reality is that all oral supplements offering a 'quick fix' are using ingredients (usually herbs: plant derived drugs) that merely mask, cover, or block. While they can help with the pain, they ultimately allow the body to continue getting worse, and often causing further injury or problems.

2. The best long term option Promotes actual healing, by supplying the body the building blocks necessary to help the body heal itself (when possible), in forms it can readily use.

This second option is not the 'quick fix.' It does not eliminate the  pain and suffering in hours or days, but over time... as healing occurs.  But it is far better for the body. (Hint: if you're in pain, use pain  killers as prescribed, as necessary, but never daily, for prolonged  periods of time!)

Next, it's important to understand that most all drugs , including most plant derived counter parts
offer  'drug activity' (medicinal herbs) in the correct dose, with the correct  usage, and can be very beneficial (especially in hormonal balances) for  a time. However, medicinal herbs, as with all drugs, are seldom  ever recommended or prescribed for daily prolonged use by  professionals, because the majority of the drugs WILL result in 'the  RANTS' (one or more of the following):

R - Resistance or immunity (you need more and more to accomplish the same thing).
A - Addiction.
N - Negative interaction with other drugs ... or treatment processes.
T - Toxic effect, build up, or overdose (often slowly impacting the liver or kidneys, or even the brain, over months or years).
S - Serious Side Effects.

For these reasons herbs not belong in any daily supplementation intended for prolonged use! The companies manufacturing, promoting, marketing, selling, and delivering such should honestly list proper use, all known side effects, valid concerns, and honest dangers. Sadly, most don't, won't, and the combination of their irresponsibly and the consumers overuse and misuse of some of the supplements is why some groups push for more regulation of dietary supplements.  More sadly, the vast majority of herbs have little to nothing to do with 'diet.'  People really need to understand, and remember, "Just because things are "natural" doesn't mean that they are natural to the body or that they are good to use daily." ​Or that they will remain 'good' if over used or misused.​​​

Despite having wrist, elbow, and knee surgery prior to meeting the doctors before the company was started in 1995.  I was fast growing, 6 foot tall in grade school, six six and a half when I graduated. Tall, skinny, and a bit uncoordinated for many years. Consequently, from age 5 to about 40 I averaged at least one broken bone per year, minimum (some years more, some accidents involved more that one broken bone, sprained joint, or twisted limb). Evil Knevil and Zoro were two of my hero's growing up. I was a bit clumsy, until I was in my late teens, then I became a bit of an adrenaline junkie (now mostly retired, at nearly 60 years old). 

I was a service project away from Eagle Scout, with every merit badge that existed at that time. I enjoyed exploring, challenging myself, learning, and doing a variety of things, like, skating, bicycling, skiing, kayaking, scuba diving, bungey jumping & zip lines, coasters & sling shots, climbing, as well as assorted sports activities. 

I often pushed my limits, doing things most people wouldn't try. I've had motorcycles jumping over me, horses stampeded directly at, and past me, been over 90mph on the water, nearly 150 on a motorcycle, nearly 200 in a car. I loved pushing the limits, and have been around a wide variety of unique situations over the years. However, occasionally I over estimated my ability (or the situation), or  miscalculated, and consequently got hurt.

Arthrosamine capsules easily gave me over 20 years of joint health back! I'm a firm believer in the benefits this product has to offer. I faithfully use it everyday!

Terry Mercer, Computers & CamerasWeb Development & President, MD's Choice

Natural isn’t always “safe” or necessarily any better than the synthetic versions.
Just because things are "natural" doesn't mean that they are natural to the body or that they are good. Both are concepts of scientific reality that are contrary to a lot of companies' marketing material, and what a number of  seemingly good people will attempt to tell you. They either don't know any better, or are like that proverbial old west 'snake oil salesman' that just doesn't care what the truth really is, so long as they can make a buck (or 50) from you.

The reality is that negative effects may take days,  weeks, months, and sometimes even years. A lot depends on just exactly what might be causing the negative, as well as the individual body, the quantity  taken, a person's diet and exercise routine.  It is also important if any drugs,  or other supplements are being used, quality of the  ingredients ingested,  and the specific drugs and herbs used... as well as, where it  came from, and how  it was sourced, produced, and processed.

The one  thing that is certain is that every single drug in existence  whether  "natural" or synthetic... DRUGS will eventually cause one or more  of the  above four problems if they are overused, misused, or abused,  and even when used  daily for more than a few days at a time. Even  Echanacia, which is one of the best 'natural' immune system boosters available from nature,  is recommended at no more than 3 weeks (21 days) on... and at least 10 days off... or the body WILL BECOME IMMUNE TO IT!

The use of  some herbs  can even prove to  be life-threatening. For example, a person  taking a  regular dose of  just ten milligrams of ginko biloba, or many   other 'herbs' &  spices can NOT undergo certain major surgeries   because they could  bleed to death (God help them if they were also   taking some type of  blood thinner, or blood pressure medicine at the   same time). Tumeric  is another amazing 'medicinal herb' (especially  when combined with  curcumin and black pepper)... BUT it too is a blood  thinner, and too  much really can hurt you.

Some herbs, drugs, and ingredients have other 'side effects' - problems, concerns, and indicators that most bodies should try to avoid, because of the very real third-party science relating to their long term use, common misuse, over use, and abuse. Health and safety should be a valid concern, and worthy of your time to research which company you can trust. There are some herbal ingredients, as well as heavy metals (often found in some minerals), that do not have an immediate effect. They gradually build up in the liver, kidneys, brain, and lungs... until those organs stop working.

When choosing a joint supplement ("flex product") the first thing you have to decide is do you just want to make the joints temporarily feel better or do you want to help solve the problems that are causing the pain. The ingredients most commonly added to joint supplements are there either to mask or cover symptoms (pain or inflammation), not to address the underlying problems that are causing the pain.

The reality is that a product intended for daily use, for a prolonged period of time cannot safely and effectively do both. Drugs, which include most herbs, can quiet pain very quickly and effectively. However, for a body to use the building blocks provided through good nutrition to actually rebuild tissues, it usually takes at least 4-8 weeks for the pain to be reduced. If there are spinal and cartilage issues, it will take even longer.

We don't enjoy pain, but pain serves a very important purpose: it lets the rest of the body know that something is wrong. When a joint hurts, the natural response is for the other joints to do more of the work and let the painful joint rest. When there is a problem, such as an injury, a body's natural reaction is to try to 'baby' that painful joint... which can help (if the proper nutrition is there to feed the body what it needs to heal). However, it will also add extra wear & tear on the OTHER JOINTS (used to compensate for the injured joint). During that type, not only can the cartilage be at greater risk, but if that other joint also had issues, they will ultimately become multiplied with the extra use... and muscles on the initial damaged joint can atrophy some over time, depending on their use and downtime. So, it's really one of those proverbial 'double edged swords.' You don't want to be in pain, you can't just sit (lay or stand) around, you don't want to make any other matters worse... and you don't want to be living on pain killers or blockers... but it all TAKES TIME and the proper nutrition to fix the problem(s) the right way (and safely).

On their own, joints heal very slowly. But, if a damaged joint is feed the proper and necessary nutrients (through diet or supplementation), and isn't rested, it will certainly get worse.

In addition to not having the joint work as hard, the immune system supplies it with more blood than usual. This extra blood feeds the joint more nutrients so that it can repair faster, but it can only do that if those nutrients EXIST (again, in the diet or supplementation). 

This natural healing process causes pain, inflammation, and swelling (results in actual symptoms).

However, trauma is not the only way joints get damaged. Normal use over time can lead to degeneration and breakdown.  Running, jumping, pounding, carrying heavy loads, and normal daily  movement all accelerate joint problems. Degenerative changes cause the  normally smooth cartilage to become rough due to a loss of chondrocytes  (the cells that make cartilage, fluid and connective tissues for the  joint). When this happens, they do not produce normal synovial fluid or  connective tissue, and pain becomes a symptom.

In traditional medicine, immediate masking of pain is accomplished  through the use of drugs that are placed in the body either orally or by  injection. These drugs (including herbal ingredients, which are plant  drugs) change the way the body normally functions so that pain is not  recognized and/or the immune system stops the inflammatory response (and  slows the healing process). The main types of drugs used are steroids  (such as Cortisone or Prednisone), NSAID's – non-steroidal  anti-inflammatory drugs – (such as Banamine, Phenylbutazone, Ibuprofen,  Ketofen, or Aspirin), or other drugs that alter the recognition of pain  or interfere with the immune response.

Steroids and NSAID's  may cause joints to deteriorate faster than if these drugs had not been used. These chemicals interfere with how tissues are made and how they heal.   Since the pain is masked, they play a role in how the workload is   divided among joints, slowing the healing and increasing the risk of   further injury. Some of these drugs also decrease the joint's ability  to  use sulfur, which gives connective tissue its elastic strength.

Many of the "flex products" on the market contain herbs which do not contribute nutrients (building blocks) to the joint tissues. Don't be fooled by the words "all natural" or "organic". Remember, there are many poisons found in nature. Since plants can't fight off insects or animals that want to eat them, many used as ‘herbs’ contain chemicals. And these chemicals are their ‘defense mechanism,’ which causes changes in the way the predator's body works.

These chemicals do many different things.  Some act like the animal's own hormones (like steroids) and many actually attack the body's immune system. Depending on the specific plant, the amount eaten, and the size and type of animal or person, ingestion of herbs and their chemicals can cause death, abortions, seizures, or an altered activity of the nervous system.

Herbs can also be used as antibiotics and anti-fungals because they can also kill bacteria and fungus. Some of the most common herbs used in joint products and the type of chemicals they contain are: Yucca: Yucca contains steroid saponins. These chemicals are related to the steroids. In the animal's body they decrease pain and inflammation. They also decrease the immune response, and steroids have been shown to slow the production of glycosaminoglycans (GAG's), which are a major component of joint tissues.

"Natural" Doesn't meaN what some claim

Since plants can't fight off insects or animals that want to eat them, they contain chemicals that cause changes in the way the predator's body works. These chemicals do many different things. Some act like the animal's own hormones (like steroids) and many actually attack the body's immune system. Depending on the specific plant, the amount eaten, and the size and type of animal or person, ingestion of herbs and their chemicals can cause death, abortions, seizures, or an altered activity of the nervous system. Herbs can also be used as antibiotics and anti-fungals, because they can also kill bacteria and fungus.

Some of the most common herbs used in joint products and the type of chemicals they contain are:

Yucca contains steroid saponins. These chemicals are related to the steroids. In the animal's body they decrease pain and inflammation. They also decrease the immune response, and steroids have been shown to slow the production of glycosaminoglycans (GAG's), which are a major component of joint tissues. The main use of Yucca in animal feeds has been to promote feed efficiency and growth, while lowering the amount of ammonia in the manure (so that it won't smell as bad).

Science has proven that animals with daily prolonged use of Yucca have joints that appear to age much quicker. However, because these animals have a limited life expectancy, the results are ignored.  For livestock, it probably doesn't matter... but for people, human joints, animals that are supposed to live longer than 2 or 3 years, it should absolutely matter!

Boswellia, White Willow's Bark, and Snake Root. These are all herbs containing chemicals that act as NSAID's. These drugs decrease pain and inflammation and are known to cause severe gastrointestinal (GI) problems such as ulcers. These drugs should not be used in people or animals with GI problems. Remember that gastric ulcers digestive problems are already common because of our fast food diets, junk food, alcohol, sodas, and irregular eating habits.

Bromelain:  This is an enzyme found in pineapples. Yes, it has been shown to reduce the amount of swelling present in some experimental animals and people. However, Bromelain can enter the body intact because it eats away the outer lining of the GI tract (something any body with digestive issues should absolutely avoid). In addition, in cancer patients, it has been shown to stimulate the body's own immune system to kill the body's own cells. Since it is a protein, it can cause allergic reactions. People who merely handle bromelain on a daily basis for a few months have become highly allergic to it.

Devil's Claw.  This herb contains several chemicals that are reported to decrease pain. They do not decrease inflammation and are similar in structure to steroids. It is generally easier on the digestive tract than Bute, or many of the other common herbal pain killers.

However, Serious WARNING: This herb should not be used with any female (human or animal) that is pregnant, or actively breeding with the purpose of getting pregnant, as it has been reported that it can cause abortions by stimulating uterine contractions. There is over 4,000 years of evidence, in African Culture and Chinese medicine, of this particular herb being used to terminate pregnancies in the early stages and induce labor in the later stages. Yet you'll see it in many American joint supplements, sometimes without any such critical warning.

Is it because they don't know any better, or just plain don't care?

Even "Natural to the body" is sometimes a concern

Glutamic Acid (Glutamate or Glutamine).

While this is not an herb, it should be mentioned because of its role as an excitatory amino acid (EAA),  because mega doses are actually being used in some joint supplements, marketed for daily prolonged use. (which should be a concern)

When this amino acid is added to a brain, it causes seizures. Higher than normal concentrations are present in the brain of seizure patients. Research is being done to see whether blocking its activity will help control seizures. It is also being considered as an antidepressant drug, and for treatment of Parkinson's, because it is a synaptic inhibitor.

This amino acid is also naturally produced and released by joint nerves, in a healthy mammals body, to signal pain (and essentially 'leave bread crumbs' for the brain to 'send' extra nutrients to the right spots, to begin the healing process... assuming the necessary nutrients are in the diet or supplementation).

Continued >>

Ask yourself, logically, if that is how a healthy body normally deals   with this amino acid, what all really happens  when an otherwise   healthy  body is flooded with it.

Science has shown, in a healthy mammals body, the more glutamate that is naturally released, the more pain that is felt in a joint. So, when companies using this ingredient claim pain relief, and 'quick results,' they might be right... but not because it is fixing anything! Watch for mood changes, neural issues, and know that in high doses this nutrient is likely only confusing most mammals bodies, and merely blocking the brain   (and really messing with their brain synapses and nervous system), especially with daily prolonged use. There are professional athletes that break bones, tear vital parts...  and with enough pain killers & blockers attempt to keep on playing,  competing, and trying. Often to only make matters worse.

Injecting  a joint directly with glutamate (glutamic acid) produces pain, because  this amino acid is naturally released by joint nerves to signal pain.

Continued >>

A popular "flex product" that contains glutamic acid claimed a '5 day cure' for the longest time, but as of 2016, we believe they either changed or discontinued that product, or toned down their rhetoric and misleading advertising, as we've not seen or heard much about it over the last year. They claimed it in their product was because 'glutamate' is a precursor to 'glucosamine.' Caution is given here because a review of this product in a popular publication discusses its dramatic and swift change in attitudes (horses, in particular). Research is being done to determine its role in seizures and the signaling of pain.

    What will daily prolonged overuse do?
    At what levels does it become dangerous?
    How addicting is it?
    How does it mess with the brain?

    These are only some of the questions NOT clearly answered by science over the last couple decades, since it just started showing up in some joint supplement products (most preaching a ‘quick fix’). The only things that are sure: in some bodies, it seems that it might help mask pain, but there is zero actual science showing it helps heal anything.

    Marketing makes somethings defy reality

    Consider the scientific reality of H A injections.   Used to replenish the synovial fluids , but doesn't do anything with the  ligaments, tendons, or cartilage. (except as a side effect of having  improved lubrication on THAT JOINT). It's real, and if synovial fluid is the problem, or a primary component of the problem, the results will be  almost immediate... because of where and how it is administered.

    At  best, these type of injections are like squirting W D 40 on a squeaky  hinge. It does nothing to the bent frame, the rust, or door's structural  problem, but absolutely adds lubrication. It really masks a symptom of  the rusty hinge or broken frame, for a time. Until the hinge starts  squeaking again, or finally falls apart at some point in the future. The  length of time will very, depending on the condition to begin with...  the continued use, the care in future use, and any other repairs (or  treatment) happening to it.

    The reality is that H A injections alone can only help a limited amount of specific and direct joint issues. Generally only those related strictly to the synovial fluid (lubricating fluid). It  is important to understand HOW the non-oral (ie. pure liquid)  version  of Hyaluronic Acid (H.A.) is used.  When a doctor uses H A they INJECT.

    Notice: most H A injections are done I A (intra-articular – directly in the afflicted joint), rather than I M (intramuscular - directly in the muscle) or I V (intravenous – directly  in  the blood stream). Positive results are less likely I V, and nearly   impossible I M. It's been proven scientifically, tested both in the  field  and clinically over the last 20+ years. So, what about oral H A then?

    CONSIDER: If it's known to be significantly less effective when directly injected   into the body via I M and I V, one must rationally ask: "How can H A effectively get to the joint going through the digestive tract?"

    Also, molecularly, H A is absolutely larger than Chondroitin Sulphate (C S),   which science has proven only 8 to 10% of the C S  can make it into  the  blood stream. So, the next question is: "How much oral H A do you   think actually gets into the system?" These aren't new questions, with oral H A studies occurring the last 3 to 20 years by third parties  have  consistently shown only about 5% can be found to be absorbed 'in  the  body' with the majority of that mere 5% being found in the bone  marrow  and spinal column, and a fractional amount in the synovial  fluids.

    Over 90% of the oral H A passes through the system and is found in the poop in less than 24 hours. That makes some dang expensive manure!

    Two  of the most interesting studies were done by Wieder Int'l - one on    rats, another on beagles (dogs) the results of both were consistent in what amount of radio tagged materials passed through the body, and where the  small amount that was absorbed was found (the majority (over 90%) never made it  to  the  joints).

    Interestingly, all  professionals  that  have actually paid attention to the science inject  directly INTO  THE  JOINT to have a direct and real positive impact on  the synovial  fluid  of that joint. They don't use Oral H A to treat anything!

    Oral H A (Hyaluronic acid, which is also known as hyaluronate, also called hyaluronan, and is an anionic, nonsulfated glycosaminoglycan), may be an effective painkiller, for a time.

    Another important scientific note: H A is also a component of the group A streptococcal extracellular capsule, and is believed to play a role in virulence. (Just wrap your head around that one).

    Yet, in reality, injecting  directly IN THE  JOINT  is the most  challenging, dangerous, for a  variety of reasons  (especially  for  Equine Vets). But that is exactly  where 99.9% of the  H A  injections  occur by the professionals. Not  directly into the blood   stream which  is safer, and not in the muscle  which is so much faster  and  easier...  and more effective systemically,  with most 'medicines,'  but  that  isn't how H A injections are given.  Which should give all  thinking   people some pause, when the  professionals won't administer it    systemically... at a higher risk.

    Then,  when science shows the    ingredients (the H A) doesn't survive, and  isn't properly broke down   or  readily absorbed through the digestive  tract, with the vast  majority   ending up in the poop (up wards of  90%)... the little bit  that was   'taken up' was actually found in the  spinal column and brain  stem, one should wonder just exactly what it does in the body. It     would stand to reason that it should be able to help all joint   tissues   in the body when injected directly into the blood stream...   yet it   doesn't. Therefore, it's not administered that way by the   trained   professionals.

    Also, H A is made from rooster combs   and bovine   eyeballs... while  natural to the mammals body, it is a   non-native form   (foreign to the  body) not ‘designed’ for food stuff.

    Excerpt  from  the review  summary- "…dietary supplements containing H A are   not   equivalent  due to the inherent properties of the three major  types  of H A   commercially available as dietary supplement materials.   Consumers    and health care professionals need to be aware of the   different types   of  H A  and their very large differences in  properties  (even before    ingestion). One source, hydrolyzed chicken  sternal  cartilage, is   clearly  unlike native H A it does not match  the real  biological   properties of  native H A and consequently  should not be   represented  as H A to  consumers on product labels..."  yet  supplement  manufacturers regularly  use this type of H A  for oral   application,  many claiming  it's a  'miracle.' At best, a smaller   percentage might be  actually used,  but not  by the actual joints, and upwards of 90% still passes through  the body  (unused).

    Again,   upon evaluation of  WHERE the little  bit that  remained in the body  was  actually found (the  spinal column and  brain  stem), it's highly   likely, though  unsubstantiated, that the  effects tend  to lean toward   Cox-2 inhibitors  (pain blockers and maskers  - similar to  what Vioxx   did, before it was  pulled from the human  market). Oral H A is positively NOT 'building blocks' or nutrients otherwise considered 'healing promoters' (or agents) regardless.

    Further, H A is also a major component of skin, where it is involved in tissue repair. When skin is exposed to exessive U V B rays, it becomes inflamed (sunburned) and the cells in the dermis stop producing as much hyaluronan, and increase the rate of its degradation.  Hyaluronan degradation products then accumulare in the skin after U V exposure.  Sounds good, right? Well, read on...  

    Hyaluronic acid is, thus, often used as a tumor marker for prostate and breast cancer. It may also be used to monitor the progression of the disease.

    In some cancers, hyaluronic acid levels correlate well with malignancy and poor prognosis. H A is, thus, often used as a tumor marker for prostate and breast cancer.  It may also be used to monitor the progression of the disease.  It is important to note that the various types of molecules that interact with hyaluronan can contribute to many of the stages of cancer metastasis, i.e. further the spread of cancer. H A synthases (H A S) play roles in all of the stages of cancer metastasis. By producing anti-adhesive HA, HAS can allow tumor cells to release from the primary tumor mass, and if HA associates with receptors such as C D 44, the activation of Rho G T Pases can promote epithelial-mesenchymal transition (E M T) of the cancer cells.

    During the processes of intravasation or extravasation, the interaction of H A S produced H A with receptors such as C D 44 or R H A M M promote the cell changes that allow for the cancer cells to infiltrate the vascular or lymphatic systems. While traveling in these systems, H A produced by H A S protects the cancer cell from physical damage.  Finally, in the formation of a metastatic lesion, H A S produces H A to allow the cancer cell to interact with native cells at the secondary site and to produce a tumor for itself;

    (Bharadwaj AG, Kovar JL, Loughman E, Elowsky C, Oakley GG, Simpson MA (2009). "Spontaneous metastasis of prostate cancer is promoted by excess hyaluronan synthesis and processing". Am. J. Pathol. 174 (3): 1027–36. PMC 2665762 Freely accessible. PMID 19218337. doi:10.2353/ajpath.2009.080501)

    In contrast to drugs, either synthetic or "natural", NUTRITION is the science of providing a mammals body the basic building blocks it needs in forms it can actually use, to help it function properly and to build the different tissues it needs to grow, heal, and survive.

    The majority of non-traumatic joint problems can be addressed through proper nutritional support. In general, surgery is needed ONLY when a piece of the cartilage (the tissue that covers the ends of the bones in a joint) is loose and needs to be removed OR when the support structures are physically separated and need to be repaired.  (And the 'healing' period for most joint surgeries are many months, with a daily physical therapy routine required.)

    The majority of non-traumatic joint problems can be addressed through proper nutritional support. In general, surgery is needed ONLY when a piece of the cartilage (the tissue that covers the ends of the bones in a joint) is loose and needs to be removed OR when the support structures are physically separated and need to be repaired.  (And the 'healing' period for most joint surgeries are many months, with a daily physical therapy routine required.)

    Nutritional  supplements can help the body fight back and heal itself by increasing  the production of new tissues, in most other normal cases.

    Over 70 years ago, it was found that, over time, eating ground up connective tissues could actually help relieve problems associated with arthritis. So, in the 1950's and 60's, people began to purposefully consume gelatin and cartilage (shark, chicken, bovine, or Perna muscle) and these helped some.

    By the 1970's, scientists began really studying these 'ingredients' and creating actual products. They found, at that time, that the most helpful substances in them were chondroitin sulfates, or Type II Collagen.  However, by the 1990's, radio tagging was cost effective, and it was quickly learned that most (over 70%) of these type of 'nutrients' merely passed through the body, doing nothing.

    About 60 years ago, the research began focusing in on a much smaller, more efficient nutrient, which is the most basic building block of connective tissues and fluids: Glucosamine Sulphate The scientific reality is that the proper nutritional supplements CAN help connective tissues grow and heal. There is little to wonder about, if a person actually takes the time to look at the real science behind the ingredients commonly used.

    Many are truly a waste of money (or give false hope). Some actually do work - either as a pain killer or blocker, and others (fewer) as healing promotion, support, and building blocks. The truth is: there really is no 'magic bullet' oral supplement that does both, and honestly causes the body to heals in hours, or days. (As sad as that sounds). Any company claiming there is... either is purposefully lying to you (marketing around the truth), or just doesn't know any better. People of all ages who are regularly working, training, exercising or competing, puts great stress on their joints, can use the additional support. Most athletes, parents and coaches take great care to protect the outside of a young adult's body to avoid injuries. The same care should be taken inside the joints, whether we are young or old. Joints can absolutely benefit from the right extra nutrients. If joint injury does occur, proper nutritional supplementation is definitely appropriate, if not more important. As a body ages, joints naturally wear out faster than they are repaired naturally, by the body... but only if the proper building blocks exist (either in the diet or supplementation).

    Understand, contrary to the marketing hype... science has proven, that whole cartilage and its large components (chondroitin sulfates and collagen) can NOT be absorbed well by the body, though they are still the most popular components in most joint supplements on store shelves today. We believe this is because they are cheap ingredients, and easy to come by for most manufacturers.

    While large molecules, such as these, can be injected and work very well when actually injected. Most people don't realize that, when taken orally, more than 70% of the chondroitin/collagen ingredients end up in the feces (poop), within 24 hours 100% of the time! For many of the 'ingredients' on store shelves, the scientific reality of bio-availability (absorption), would kind of be like believing having a gas can full of gas in your truck is going to improve your vehicles mileage. With others, it's like thinking that pouring gas in the drivers seat will increase your mileage. (non-sense, and potentially dangerous)  Just think about that for a moment.

    Chondroitin sulfates have a large range in size. Some are 50 times larger than others. Only 8-10% of the smallest ones have been shown to get from the gut into the blood intact (meaning about 90% passes through the body, never making it into the blood stream, the body's 'nutrient super highway').

    What is fed must be broken down into smaller pieces by the gut, and the pieces that do actually get into the blood must be further broken down to get into the joints. Another concern with these large-sized, mixed animal byproducts (chondroitin or collagen) is that they can also cause allergic responses. And yes, many serious allergic responses have been documented over the last century. Lastly, regarding the chondroitin (and collagen) by-products, one should consider the source: where it came from, what type of by-products it came from (really), and how it was processed (manufactured). But, more importantly, WHERE it was actually manufactured can be even more vital to longevity, health, and safety.

    Seriously, if 'we' can not safely drink the water, why would we want any supplements or ingredients in our supplements sourced in those third world countries? Especially those that often have little to no safety standards, are riddled with unchecked heavy metals, and other common contaminants?

    MD's Choice does not, and will not, use nutrients sourced from third world countries. In fact, all ingredients come from North America (USA, or Canada with certain Amino Acids).

    The other extreme found in some supplements is the promotion of simple amino acids (A.A.'s). Yes, amino acids are the basic building blocks of proteins, and it is very important that the right amount of protein, from the proper sources, is in your food, but providing extra of a particular A.A. (amino acid) does not mean that more connective tissue will be made.

    For example, let's say you ordered some boards to put a wall on a barn and, instead of boards, the lumber company delivered a load of acorns. When asked about the acorns, the deliveryman uses the reasoning that oak is the best type of wood for your job and that, someday, the acorns will grow into trees and can then be used for the lumber you need. Obviously, the acorns will not get your job done. Unfortunately, this logic has been applied to some joint supplements with the same lack of results.

    Further, ALL products that 'promise' (and 'claim') "Quick Results" might be experienced ARE DRUGS (or medicinal herbal plant derived drugs). They are actually masking the symptoms, merely blocking pain, and are NOT A SOLUTION, but in reality CAN HELP MAKE THINGS WORSE in time. The cause of the problem isn't being treated or addressed... and because the joints are still being used, often over used or abused, the problem grows. More, and often different, pain killers and masking agents become more necessary just to make it through the day (to the point of surgery or immobility).

     Awareness of your goal, expectation, and reality is important.

    Fact - Glucosamine Sulphate is the basic building block of connective tissues and fluids. 

    Studies  have shown that when Glucosamine Sulphate is given orally, within 30  minutes, 87-97% is actively taken from the gut into the blood.  Furthermore, within 4 hours, the chondrocytes (joint cells) have  actively taken it from the blood. When linked together with sulfur,  chains of glucosamine become several different types of connective  tissues and joint fluid. (A lack of sulfur will cause the production of  connective tissues to stop .)

    In addition, an enzyme can slightly  change the shape of the glucosamine so that it is also the basic  building block of the chondroitin sulfates. Oral Glucosamine Sulphate has been scientifically shown to return people suffering from arthritis and osteo-arthritis to normal  function  within a few weeks to months (not a few days).

    There are other types of glucosamine in different supplements, but they are not the same as Glucosamine Sulphate. Below are some facts about two other forms of glucosamine that are used in some joint products.

    N-acetyl-glucosamine: This type of glucosamine has been proven to have no active uptake from the gut.
    Many  of the large budget marketing campaigns are written by the marketers,  who don't have a clue about nutrition, absorption, bio-availability or  effectiveness.
    Most doctors are NOT nutritional specialists and only took one or two semesters of nutrition in college.

    Glucosamine HCl: There are no studies that show if Glucosamine H.C.l. molecule is  actively taken in from the gut or how much of it can actually gets into  the body or the joints. (Most show more than 50% of 'the best'  glucosamine hcl passes through the system, and then it has to be  combined with a sulpher source (like chondroitin). Understanding that  whatever portion that does make it into the joints MUST  undergo  molecular changes before it can be used in connective tissues is vital  to science (and reality). The H.C.l. molecule MUST BE removed and a  sulphate added for that type of glucosamine to actually be usable to or  by a body.

    (See note below.) Furthermore, Glucosamine HCl is not stable in liquids. Published experiments have shown that over half of the Glucosamine HCl added to a liquid solution will breakdown within 27 hours. Within 4 days, these new and different "breakdown products" form completely different molecules that were 20 times larger than what was originally in the solution. All of this often happens BEFORE the product leaves the manufacturer!

    The doctors at MD's Choice specialize in nutrition and preventative health for both human beings and animals.


    Educating is one of their core goals.

    M.S.M. (Methyal Sulphanal Methane) is biologically active sulpher ...

    and the particular variety MD's Choice uses is based on 26 animal patents, 26 human patents, by the original 'inventor' 
Dr. Bergstrom, and his company Bergstrom Nutrition, which exclusively manufactures Opti-M.S.M in the U.S. They have many long term studies, over the last 60+ years, on safety, effectiveness, use, lack of toxicity, and benefits to mammals (people and animals). It has been scientifically proven impossible for a mammal to overdose on,

    What the body doesn't use, of their M.S.M. (which is the ONLY type of M.S.M. MD's Choice uses)... it passes through. There is no toxic build up, no known negative interaction with other medication or treatment. However, with that said, there are five other company's in the world which have attempted to copy the Opti M.S.M. ~ one in Alabama, one in South America, two in China, another in some more remote third world country.

    Just like pie's aren't the same: Apple isn't Pumpkin, isn't Lemon Meringue, and it isn't just food or desert, verses Mud... there are significant differences. Far larger than what brand of gas you use in your vehicle (though the potential for contaminates and improved mileage because of quality absolutely exists in the nutritional ingredient world.

    However, in nutrition, the differences are significant and important! And are far beyond just 'taste,' or personal choices, but hit actual safety, absorption, and effectiveness issues. and those differences are really more vital than just taste or smell, but what OTHER INGREDIENTS are used, and what 'contaminates' might be included in the M.S.M. (and other ingredients) that other companies make (and use), their purification process, and the care behind their manufacturing process.

    At least 4 of the M.S.M. manufacturers are in countries 'we' wouldn't want to drink their water, so the purity and contamination of other substances should be of concern, and a valid question Especially since M.S.M. is a 'carrier' for other nutrients, and that was a serious concern the doctor's at MD's Choice considered when selecting the form and type they use, and where all the other ingredients in the products came from. Again, these 'other' forms of M.S.M., especially those created in other countries and shipped to the USA, should be a concern... and is the reason for the questions:

    WHERE DOES the M.S.M. used in your products come from? 
Where were the RAW bulk ingredients originally manufactured?

    M.S.M. occurs naturally in all meats, fish, poultry, eggs, milk, dark green vegatables, kelp, and algae among others. It is also naturally and normally found in foods containing sulfur, which are include grains, legumes, fresh unprocessed vegetables like garlic, onions, cabbage, broccoli and brussels sprouts.

    As of 2017, any American supplement company claiming THEY 'manufacture' 'their' own M.S.M. is LYING! Because neither U.S. manufacturer of M.S.M. 'creates' their own line of mixed products (containing their MSM). They focus on bulk, raw M.S.M. only.

    Chinese-made M.S.M. is generally not distilled but uses a crystallization process that traps contaminants (away from the active ingredients).  Either way, it suffers from lower purity levels, a higher presence of unwanted chemicals left from the manufacturing process, and a higher water content, which leads to decomposition and increased contamination. They also frequently use lower quality raw materials to save costs. Chinese, and other third-world factories, undergo few of the health and safety inspections and safeguards. They lack the “Good Manufacturing Practice” (cGMP) certifications that American manufacturers are obliged to. So why chance using their 'biological carrier' (M.S.M.)?

    What all was it tested for?  What were the ingredients they are  combining it with tested for? Because M.S.M will carry stuff into the body... into the blood stream, What ever it's attached to... so making sure there are no heavy metals or other containments is vital. Responsible manufacturers will also seek third-party testing for their finished products.  These safeguards will ensure that each batch made is put through extensive analytics to ensure the absence of lead, arsenic, cadmium, aluminum, mercury, and microbes.

    For quality M.S.M. 

    There are four additional tests that  establish purity, quality, melting point (important to verify quality), water content (low water content is essential for stability),  and shelf life. That information isn't public knowledge... but key to the reason MD's Choice uses the Opti-MSM. 

    People forget that herbs and spices CAN BE DANGEROUS... and really are "PLANT DERIVED DRUGS." 
    Yes, while some may be common or seem harmless to most people, most of the time, some are really deadly. Some are just dangerous under certain circumstances, over certain amounts, while others are fine topically... but deadly if ingested. Some are ok for culinary use, but not supplementation. All the while, others can be deadly to people with blood pressure issues, heart concerns, kidney or liver issues, and others dangerous only to breeding or pregnant mammals (yes, that includes people).

    EVERY SINGLE herb & spice on the list below should be avoided without specific instructions of a healthcare professional. 

    Aloe Vera
    American Pennyroyal
    Arbor Viae
    Autumn Crocus
    Balm of Gilead
    Basil Oil
    Beth Root
    Black Cohosh
    Blessed Thistle
    Blood Root
    Blue Cohosh
    Chaste tree
    Clove Oil
    Cohosh (see black, blue, and red)
    Cotton root
    Cumin Seed
    Dong Quai

    European Pennyroyal
    False Unicorn Root
    Golden Seal
    Gota Kola
    Gravel root
    Greater Celndine
    Horse chestnut
    Juniper berries
    Juniper Oil
    Kava Kava

    Kola nut
    Lady’s Mantle
    Lady’s Slipper
    Lemon balm
    Life Root
    Lily of the Valley
    Ma Huang
    Oregon Grape root
    Passion Flower
    Peruvian Bark

    Queen of the Meadow
    Red Clover
    Red Cohosh
    Roman Chamomile
    Saw Palmetto
    Senechio Aureus
    Shepherd’s Purse
    Tea tree
    Tien Chi
    Vitex Agnus Castus
    White clover
    Wild Yam
    Witch Hazel
    Wood Sorrell

    Much more information on Herbs can be found on-line. PubMed, WebMD, and are other resources worth checking out if you need more info.

    Important Points

    Remember these:

      • Nutritional support can most definitely help maintain and heal joint tissues.
      • Be an educated consumer.
      • Ingredient quality is extremely important.
      • Be sure that you are buying the proper building blocks in the supplements you purchase.
      • Be sure that when you use a daily supplement, you are providing nutrition, not drugs.
      • Is the product formulated by professionals to address structural problems or is designed to cover pain. ? Professionals that understand the differences in nutrients, and want to address structural problems... or just  cover pain or mask symptoms?
      • Structural changes through nutritional supplementation take weeks, not days, to be seen.
      • Beware of "one size fits all" doses. The amount of nutrients needed by an individual is based on weight, age, and severity of the problem or deficiency. , other medications and treatments, and personal goals. For example:

        ~ An athelete, attempting to prepare for their next competition, will benefit more from a slightly higher dose than the average person.  
        ~ In general, a younger person will need less than an older person.
        ~ A large person more than a smaller body.
        ~ A seditary person less than a competitive and highly active one.

    If you are shopping for (or using) a joint supplement, you absolutely want "Glucosamine Sulphate" in that product, preferably the  2KCl (potassium) form.,

      • Not Glucosamine HCl
      • Not Chrondroitin Sulphate
      • No Herbs
      • No Fillers
      • Not some 'magic' ingredient of the month
    For more information on the MD's Choice products, and other high quality supplements, which don't use herbs or any of the unproven and often money-wasting ingredients that only make a fraction of the possible difference, please visit 

    The MD's Choice joint supplements are purposefully not liquid... because of the reality of the science! Contrary to the marketing hype: Glucosamine is NOT STABLE in liquid!

    MD's Choice's products provide the other necessary basic building blocks to target the joint tissue, in high concentration, in forms the body can use. They do not mask the symptoms or kill the pain. However, just like the rest of the body, joints need to be fed every day, preferably 2 or 3 times a day, not just once a day, or every 4 - 6 weeks. Remember, the fastest, most effective, and economical way to address serious joint and connective tissue problems is to start a high quality oral supplement BEFORE the problem exists.

    Preventive measures can really help a body be its very best, for the longest time. The MD's Choice joint formula actually helps improve the synovial fluids, but, more importantly, it also strengthens the ligaments and tendons (and all other connective tissue and soft tissues), and supplies the body (systemically) with basic building block nutrients required to help the body build healthy joint tissue, in forms the body can readily use. (Yes, that's a mouth full).

    With the MD's Choice joint formula, the ingredients are generally  absorbed into the blood stream within 30 to 45 minutes, and can be found  in the actual joint tissue within 4 to 6 hours. That does not mean it's  a 'quick fix' or relief will happen right away, it's nutrition - not a  pain blocker or masker. It means that the body is getting the basic  building blocks it needs, in the forms it can use, so it can start  healing faster, easier, and better than it would have without those  extra nutrients. It means the pain will decrease and go away over time,  as the healing occurs. In other words, the MD's Choice joint formula  does a whole lot more (and better) than oral H.A. by itself. And is  better for the body than symptom blockers and pain killers. However,  because of the potential for pain blocking in some bodies, which oral  H.A. has shown with some, a few customers have reported a faster  positive impact when they used oral H.A. in conjunction with MD's  Choice's joint supplement.

    MD's Choice has purposefully and  knowingly avoided adding any pain killers and symptom blockers to their  products, with the firm scientific belief that any such masking agents  do NOT belong in a DAILY SUPPLEMENT INTENDED FOR DAILY PROLONGED USE.

    Like  any 'pain killer' - IF a person is going to use oral H.A.. it should be  limited, controlled, and only used as needed... when needed... and  daily use for more than 2 to 4 weeks at a time should be avoided.

    MD's Choice has three primary joint supplements -

      • Arthrosamine Capsules for human beings, and smaller bodies. often used for toy dogs & cats
      • Arthrosamine Beefy Chewables for dogs (perfect for those under 150 pounds, the powder is recommended for larger dogs, as well as those with 'beef liver' allergies)
      • Gluquestrian - powder for horses, and body's over 200 pounds (Yes, people use the powder, mixed with a variety of liquids (it just has to be ingested the same day it's mixed)). It's also used for large dogs, and a variety of other mammals.

    Remember, the MD’s  Choice  products are PURE NUTRITION! 

    The formulas on  the key products  have not  changed since 1995, and It remains one of  the most effective,  most  consistent, most bio-available (absorbable),  and best 'joint  formulas'  on the market.

    The prices have  remained the same since  1998, with  discounts and rewards available for  people purchasing  multiple  containers at the same time. Including  Current and  Ex-Military, current  and retired FOP Members, Fire  fighters, k-12  educators, FFA, 4-H  members, M.M.A. Competitors, NCAA  and Olympic  Athletes because we care…  and know our product can help  make a  difference in bodies of all ages.

    The  Doctors that  formulated  these products have NEVER DRAWN A SALARY from  MD's Choice  (or that wasn't why they did it;They  wanted   consistent high quality products for themselves, their family &  friends, patients and clients, but ultimately:

    They wanted to help change the world... ONE BODY AT A TIME!

    Important Notice: 

    G A I T​​​​ (linked, and will open in a new tab/window) was finally released. Those initials stand for "Glucosamine-chondroitin Arthritis Intervention Trial Primary Study." 

    The study was initially supposed to span just six months. However, because the initial results some of the supplement companies using 'glucosamine-chondroitin' didn't produce the findings they hoped, it was expanded. To nearly nine years, involving thousands of test subjects, spanning multiple universities, dozens of doctors and hundreds of students. All closely monitored by the NIH (National Institute of Health... which comprises 27 separate Institutes and Centers, and is one of eight health agencies of Public Health Service, which, in turn, is part of the U.S. Department of Health and Human Services. A tax payer funded division in the American government, dedicated to 'health: diet and nutrition' who answers to the F D A  and C D C, and congress ).

    You can read their findings for yourself, but the conclusions were what the doctors at MD's Choice knew over 20 years ago: Glucosamine H C l is ineffective, and very little Glucosamine - from Glucosamine H C l actually gets into the joint tissue! Yet, still today, many of the "Glucosamine" supplements in national chain stores, on tv adverts, contain this form of Glucosamine rather than one of the Glucosamine Sulphate forms.

    How is that even possible? Well, it's science. Because Glucosamine H C l does not contain a sulphur source. Therefore, has NO SIGNIFIGANT or POSITIVE EFFECT on a mammals body in that form. 

    The fraction of Glucosamine H C l that does actually go somewhere within the body must - not might, should, or may... but MUST undergo molecular changes before it can even be used in connective tissues. The science shows the H C l must be removed and a sulphate added, for joint tissue to even know that glucosamine exists. Because of this, Glucosamine H C l is not sold by itself, but, rather, with other ingredients that provide the sulphur, usually chondroitin sulphate.  The problem with Chondroitin Sulfate is that it has larger molecules, which affects how well it gets into the joints. Even with the best Chondroitin Sulfate on the market, as much as 70% ends up in the urine and feces. How is that for an effective use of your money?

    Studies repeatedly show  Glucosamine SULPHATE 2 K C l  (Potassium Salt) and Glucosamine Sulphate N A C l (Sodium Salt) actually  get to the joint tissues. 

    Arthrosamine™, which contains Glucosamine Sulphate, provides basic building blocks to joints in high concentration and does not just mask the pain. However, just like the whole body, joints need to be fed every day, preferably 2 or 3 times a day, not just every 4 - 6 weeks. The fastest, most effective and economical way to address serious joint and connective tissue problems is to start a high quality oral supplement BEFORE the problem exists.

    We know that all of this can be confusing, and much of it contradicts the media . . . 
    but it is completely backed by science, not advertising or an ignorant marketing company. The professionals at MD's Choice care about effectiveness, usefulness, and helping to solve the problem(s) – not masking it.

    For more information on Arthrosamine™, a high quality  joint supplement that doesn't use herbs or any of the unproven and often  money-wasting ingredients that only make a fraction of the possible  difference, please visit

    Arthrosamine™ is pure nutrition for joints! They have had a mind boggling RESULTS  BASED GUARANTEE for over 20 years, maintained a A+ rating with the BBB  (zero complaints ever filed), and their guarantee isn't limited to just  30 days or 1 bottle. 

    They know the body, and the science. They are in  fact NUTRITIONAL SPECIALISTS, that either actively practice medicine or  have retired. Their goal was to help change the world, one body at a time... to help improve health, or you get your money back!

    Many  of the large budget marketing campaigns are written by the  marketers,  who don't have a clue about nutrition, absorption,  bioavailability or  effectiveness. Most doctors are NOT nutritional  specialists and only  took one or two semesters of nutrition in college.  Our doctors, on the  other hand, specialize in nutrition and preventative  health for both  human beings and animals.

    If you don't have free long distance, call 1-800-628-0997 

    with any questions or to place an order.

    865-380-0950 voice   ~   865-380-2212 fax

    Monday - Friday, 10am to 6pm EST, excluding holidays

    Dr. David Davenport, D.V.M., M.S., C.N.S.

    As a veterinarian and certified nutritional specialist (CNS) through the American College of Nutrition, he has devoted much of his time and studies to informing and educating people about the benefits of nutrition, dangers of herbs, and the fallacy of "quick cures". He believes in solutions through proper nutrition. He has spent many years in graduate coursework and research learning how to apply cutting-edge nutrition to clinical and preventive health care programs for both people and animals.

    Dr. Jim Blackford, DVM, MS, dACVS,

    Section Chief, Large Animal Surgery for The University of Tennessee College of Veterinary Medicine. As an equine practitioner, surgeon, researcher, and instructor, he understands the critical importance of connective tissue health as it relates to the overall health and longevity of the body (horses in particular).

    Dr. Michael R. Bishop, MD, PhD, FACOG 

    graduated as a Pharmacist from Purdue before obtaining both a PhD in Pharmacology and Biochemistry and a MD from Vanderbilt. He is a clinical instructor, a published surgeon and frequent speaker at scientific meetings. Over the past several years, Dr. Bishop has turned much of his attention to preventive health.

    There are many doctors, veterinarians, nutritionists, chemists, and industry professionals we owe a special thanks to. But those listed above, and below, were extra important to the formulas and foundation of MD's Choice... and helped in some vital and important ways. Thanks to each and every one of them, and their continued contributions to help keep this project alive and moving forward!

    Practicing Veterinarians:

    Dr. LeAnn Blackford DVM, dAVCS

    Dr. Martin DVM and CNS

    Dr. Carla S. Sommardahl, D.V.M., PhD, Dipl. ACVIM

    Dr. Cathy Johnson DVM

    Dr. Sam Lyle DVM

    Key People that helped MD's Choice:

    Dr. Miller PhD in Nutrition

    Dr. James Bailey a PhD in Nutrition

    Dr. Sam Lyle, DVM

    Dr. John Bennett, DVM

    Dr. Mika Bentley DVM

    Mr. Neil , CPA

    Mr. Roy Metzger, Business Advisor

    Key Distributors of our Products:

    TN Farmer's Co-op

    Valley Vet ~ National Catalog

    Henry Schein Animal Health

    KV Vet ~ National Catalog

    Bulter Animal Health

    Lextron Animal Health



    Day to Day Operations:

    Frank McAlister, COO

    Terry Mercer, President

    Carly Mercer

    Ted McAlister (Part Time Help)

    Bridgette Aldredge, Sales Rep

    April DeBusk, Sales Rep

    Russ Leamons, Sales Rep

    Janis Beorkland, Sales Rep

    Lori , Sales Rep

    Walt Patrick, Sales Rep

    All Research and Information ©1995 - 2017 MD's  Choice, Inc. and respective holders. The legal mumbo jumbo: All  information, graphics, and videos found on this site, and any sites  directly linked from this site, are copyrighted and cannot be used  commercially by any business, company, agency, or organization, without  the express written permission of the respective holder. All rights  reserved.  Science, especially nutrition, is a vital part of life... living... and  longevity. Nothing on this website, or any other, should ever be given  more power or authority than your actual doctor: that has seen the body,  ran the tests, poked, prodded, x-rayed or ultra-sounded when necessary,  thoroughly examined, and genuinely evaluated the history of the  patient. Part of the reason the FDA has regulations and requirements,  such as “These statements have not been evaluated by the Food and Drug  Administration. These products are not intended to diagnose, treat,  cure, or prevent disease.” is to help protect the consumer from false  claims, 'magic cures,' 'miracle claims,' and dangerously avoidable  contraindications (side-effects). We understand and agree! Drugs should  have quality control regulations, safety requirements, and that includes  all plant derived drugs (herbs) which have their place, but seldom ever  in a 'daily supplement, intended for prolonged use.' Supplements should  be tested for all the common contaminants, which MD's Choice has been  doing since the very beginning. Nutrition is key, good nutrition  important, but even the best nutrition doesn't replace the hands on  experience of doctors able to evaluate the individual on a case-by-case  basis. There are far too many ailments, types of diseases, genetic  issues, contributing factors, and medical issues producing side-effects  and symptoms for any responsible person - especially a doctor or  healthcare related professional - to do more than generalize or suggest  some elevated or minimized concern, without in-person testing and a real  world exam.  Our products are great, and have had the best Results Based Guarantee in  the nutritional industry for over 20 years, which should tell you a lot  about us.  WE CARE... If you have a serious concern, or life  threatening situation, PLEASE CONSULT YOUR DOCTOR, or a specialist that  can see the body, do the tests, and evaluate the individual situation.