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Nutrient Spotlight—Hyaluronic Acid

Author: Kimberly Day

Thursday, 10 September 2015

Ponce de Leon searched for it in the 16th century. Alexander the Great set out to discover its secrets. It has been revered in Ethiopia, the Middle East, India, Israel, Cuba, Spain and the Caribbean. There is even an archaeological park named for it in St. Augustine, Florida.

It is the Fountain of Youth.

You can understand its allure. To be able to revert your body back to a state of youthful health. No aching joints, decreased inflammation, fewer wrinkles, smoother skin, more zest in your life.

But what if those same health-giving, youthful benefits could be found not in a mystical river but a very real nutrient? Get ready to discover hyaluronic acid.

What Is Hyaluronic Acid?

Hyaluronic acid (HA) is a glycosaminoglycan (GAG) found throughout your body, primarily concentrated in the fluids of the eyes and joints. It is also abundant in your skin. In fact, HA is one of the main components of the extracellular matrix, the key component in all of your connective tissues, including collagen and cartilage.

While HA is involved in many body processes, its key roles include wound repair, cell regeneration and lubrication of joints and skin.1 It is also instrumental in helping your skin retain moisture.

Conditions Supported by Hyaluronic Acid

- Osteoarthritis
- Inflammation
- Gingivitis
- Wounds/ulcers
- Wrinkles
- Rosacea
- Vaginal dryness

What Does the Research Say?


A systematic review of 76 randomized controlled trials concluded that injectable hyaluronic acid is an effective treatment for knee osteoarthritis, resulting in beneficial effects on pain, function and patient global assessment.2
One example is a randomized, double-blind, controlled trial published in 2008.3 Researchers examined the effect of HA in oral supplement form on pain and quality of life in 20 subjects with osteoarthritis of the knee.

The subjects had pain for at least 15 days in the previous month and symptoms present for six or more months. They also had a Kellgren/Lawrence score—which measures osteoarthritis progression—of two or more. Prior to the start of the study, the researchers administered to the subjects the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and quality of life by the Short Form-36 (SF-36v2).

They then gave 10 subjects 80 mg/day of the supplement and 10 subjects a placebo for eight weeks. After four and eight weeks of treatment, the researchers re-administered WOMAC and SF-36v2.

Although researchers observed significant differences in the pain subscales at weeks four or eight compared with baseline in both subjects given placebo or the supplement, the magnitude of pain relief was higher in the HA group. Taking the supplement also resulted in a greater improvement in health-related quality of life compared with the placebo. In the supplement group, there were early improvements at four weeks in the physical function subscale and aggregated total symptoms score of WOMAC. In the physical subscale of SF-36v2, researchers observed a significant difference at four and eight weeks only in the HA supplement group, but not the placebo group.

Seventy-five percent of subjects in the HA supplement group reported pain relief, but only 50 percent in the placebo group. Additionally, a greater percentage of subjects in the placebo group used pain relief medication at some point during the study. In fact, subjects taking the placebo tended to use twice as much acetaminophen capsules as the HA-supplement group, although this difference was not statistically significant, possibly because of the small size of the study.


According to a lab study, hyaluronic acid appears to ease the inflammation response.4 Researchers took human skin cells and connective tissue cells from mice and added ethanol to them to produce an inflammatory response. They then added hyaluronic acid to determine if HA could reduce the inflammatory response.

After 24 hours, researchers found that the HA reduced the amount of inflammatory compounds released due to the ethanol in the human skin cells as well as the mouse tissue.


To test HA’s effectiveness in treating gingivitis, researchers divided 130 children into three groups:

- Group 1 (chronic gingivitis) – treated with basic oral care;
- Group 2 (chronic gingivitis) – treated with basic oral care plus hyaluronic acid application
- Group 3 (healthy gums) – no treatment.5

Researchers found that while basic oral care did reduce plaque accumulation and bleeding, there was a more significant reduction in inflammation of the gums in the hyaluronic acid group. They concluded, “The use of hyaluronic acid together with the basic treatment can markedly improve the treatment effect.”


Topical hyaluronic acid has been shown to accelerate wound healing—in part by protecting tissue from oxygen free radical damage6—in a number of studies. Scientists have noted its beneficial effects both immediately after the injury occurs and in long-term wounds as well. HA treatment has been reported to cause a 70 percent reduction in the surface area of wounds.7 Studies also have documented HA’s effectiveness in leg ulcers and pressure wounds (bed sores).8-9


When it comes to reducing the appearance of fine lines and wrinkles, hyaluronic acid also shines. According to one randomized, placebo-controlled study of 76 women between the ages of 30 and 60, HA may just be a woman’s (and man’s!) best friend.10

Researchers divided the women into two groups. One group received a cream containing 0.1 percent HA while the other group received a placebo cream.

After applying the cream to the skin around their eyes twice a day for 60 days, those in the HA group enjoyed significant improvement in skin hydration and overall elasticity as compared to the control group. Additionally, the hyaluronic acid group demonstrated significant reduction in wrinkle depth as well.


When it comes to treating rosacea, one study found that hyaluronic acid sodium salt cream reduced papules (raised, solid bumps in the skin), redness, burning or stinging and dryness by 47, 51.7, 65 and 78.8 percent, respectively at week four. Compliance and tolerance were excellent.11

Vaginal Dryness

Researchers randomized 72 subjects to a group treated with hyaluronic acid vaginal gel (Hyalofemme®) and 72 to the control group treated with estriol cream (Ovestin®). Treatment in both groups was applied once every three days for a total of 10 applications over 30 days.

The results indicated that hyaluronic acid vaginal gel compared favorably to estriol cream. Both the HA gel and the estriol cream significantly improved vaginal dryness in postmenopausal women. After 10 applications, the HA gel resulted in an improvement rate of 84.44 percent, while the estriol cream resulted in an 89.42 percent improvement rate after 10 applications.12

How to Use Hyaluronic Acid

There are several ways you can reap the benefits of hyaluronic acid (HA). First, if joint pain is your concern, you can work with your health care practitioner to explore the use of HA injections.

When it comes to hydrating the skin and reducing the signs of aging, topical HA creams and serums can be an ideal choice.

But when it comes to oral supplementation, a lozenge form of HA is the best choice because it helps preserve the molecular weight—and thus the activity—of the HA molecule.

When HA of high molecular weight reaches the stomach, it is broken down into smaller, less effective fragments by the acidic environment.13 Capsules containing solid HA powder are designed to work in the stomach. However, absorption of high molecular weight HA via the stomach is limited and HA administered via this route would be expected to be less effective.14

The most effective delivery of HA is via the mucous membranes, including the lining of the mouth, tongue and gums. The mucous membranes of the mouth offer high numbers of receptors to attract and bind the HA, as well as the necessary vascularization to receive the HA molecule once it is pulled through the membranes via the receptors. Extending the time that the HA molecule remains in the mouth via formulation into a lozenge extends the time allowed for absorption and increases the effectiveness of the HA.


Volpi N, et al. Curr Med Chem. 2009;16(14):1718-45.
Bellamy N, et al. Cochrane Database Syst Rev. 2006;19:CD005321.
Kalman DS, et al. Nutr J. 2008 Jan 21;7:3.
Neuman, MG t al. J Pharm Pharm Sci. 2011;14(3):425-37.
Igic, M et al. Vojnosanit Pregl. 2011 Dec;68(12):1021-5.
Trabucchi E, et al. Int J Tissue React. 2002;24(2):65-71.
Voinchet V, et al. Am J Clin Dermatol. 2006;7(6):353-7.
Dereure O, et al. J Wound Care. 2012 Mar;21(3):131-2, 134-6, 138-9.
Barrois B, et al. Drugs R D. 2007;8(5):267-73.
Pavicic T, et al. J Drugs Dermatol. 2011 Sep;10(9):990-1000.
Schlesinger TE and Powell CR. J Drugs Dermatol. 2013 Jun 1;12(6):664-7.
Chen J, et al. J Sex Med. 2013 Jun;10(6):1575-84.
Xiang Q, et al. Applied Biochemistry and Biotechnology. Spring 2003;107(1-3):505-21.
Washington K, et al. Hum Pathol. 1994;25(10):1043-9.

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