MSM Ginger and Devils Claw

Lots of people already have a box of MSM at home, so these are the questions our naturopaths ask in store.

A good fit if

• Your joint aches are mild and everyday, not a condition you're already managing with a doctor
• You'll give it around 12 weeks, since that's when the trials saw a difference
• You're happy to take 2 to 6 grams a day, not a token amount in a crowded combination tablet
• You want a sulfur-based option alongside, or instead of, glucosamine and chondroitin

Check with us first if

• You're pregnant or breastfeeding. No trial has included either group, so we'd rather be careful than reassure you.
• It's for a child or teenager. There's no trial of MSM in children.
• You take prescription medicines. No study has looked at interactions with medicines, and that's a gap in the evidence, not a clean bill of health.
• You get ongoing stomach upset. The usual side effects reported are mild and gut-related, and taking it with food usually helps.
• You're hoping for more than relief from mild symptoms. A 2019 expert panel recommended against MSM for long-term muscle and joint pain.

• Bulk crystalline MSM powder. Best known for: The simplest way to reach the 2 to 6 g doses used in the positive trials. Absorption: No trial has compared absorption between forms, but dissolving it in water raised antioxidant markers in two exercise trials. Typical use: Mild joint pain, everyday movement and recovery after exercise, at the doses used in trials.
• MSM capsules or tablets. Best known for: The same molecule in measured doses, without the bitter taste. Absorption: A 200 mg tablet, taken 10 a day for 2 g, gave a significant result in one trial. Typical use: The same uses as powder, if you'd like an easier dose to measure.
• Distilled MSM (branded, e.g. OptiMSM). Best known for: The purified form used in the exercise-recovery and 16-week safety trials. Absorption: No trial has compared its purity or absorption with undistilled MSM. Typical use: A sensible pick because it's the form actually studied, not because it's proven better.
• MSM inside a glucosamine and chondroitin formula. Best known for: The most common way MSM is sold in Australia. Absorption: Not measured separately, and the MSM dose is usually well below what trials used. Typical use: Knee joint pain, as a combination. You can't tell how much of the effect comes from the MSM itself.
• Topical MSM (creams, gels). Best known for: Allowed under TGA rules, since both oral and skin use are permitted. Absorption: There are no trials of MSM on the skin in the research we hold. Typical use: Don't assume the joint evidence from taking it by mouth applies to a cream or gel.

Reference values. There isn't one. MSM isn't an essential nutrient, so the NHMRC Nutrient Reference Values don't cover it. There's no RDI, no adequate intake and no deficiency.

Typical supplemental range. MSM-only products in Australia usually provide 1,000 to 4,000 mg a day. Combination joint formulas often give you a lot less, because MSM has to share the capsule with glucosamine and chondroitin. The trials that found benefits used 2 to 6 grams a day.

Upper level. Australia's permitted ingredients list (Schedule 1) sets no daily cap for dimethyl sulfone. The practical limit comes from the evidence instead: MSM is described as well tolerated at up to 4 grams a day, and 6 grams a day for 16 weeks didn't change any blood, liver, kidney or blood pressure measure in a placebo-controlled trial.

Worth knowing. Give it around 12 weeks, because that's when the joint trials measured their results. Nothing has been studied past 16 weeks, so longer use hasn't been tested rather than being proven safe. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Foods generally: described in the research as present in small amounts in many foods, but no per-serve figure is given in any source we hold
• An ordinary diet: doesn't get close to the 2 to 6 gram doses used in the positive joint trials
• Because MSM isn't an essential nutrient: there's no deficiency state to correct and no dietary gap supplementing is meant to fill

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• You're pregnant or breastfeeding. No trial has included either group, and Schedule 1 item 1862 has no warning either way.
• It's for a child or teenager. There are no trials in children, and no age warning is required.
• You have long-term or diagnosed joint disease. A 2019 GRADE-based expert consensus recommended against MSM for long-term muscle and joint pain.
• You take prescription medicines. We couldn't find any drug interaction study for MSM.
• You have a sensitive stomach. The usual side effects are mild stomach upsets; taking it with food usually helps.
• You plan to take it for longer than 16 weeks. That's the longest human safety data we have, and nothing longer has been studied.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.