MSM & DMSO: What Actually Works for Joints (And What Doesn't)

I'm honestly getting tired of seeing patients come in with bottles of MSM they bought because some influencer said it would "detox" them or "cure" their arthritis overnight. Let's fix this—sulfur compounds like MSM and DMSO can be helpful tools, but only if you use them correctly and understand what they actually do (and don't do).

Here's the thing—simple usually wins. I've had clients spend hundreds on fancy "organic sulfur" blends when they'd get better results from consistent, properly dosed MSM and addressing their sleep and hydration. I tell my clients: supplements should support your lifestyle, not replace it. If you're eating junk, sleeping 5 hours, and expecting MSM to fix your joint pain... well, I've got some bad news.

What the Research Actually Shows (Not What Supplement Companies Claim)

Okay, let's get specific. The hype around sulfur supplements is... intense. But what does the data say?

For MSM, the best evidence comes from osteoarthritis research. A 2020 meta-analysis published in Osteoarthritis and Cartilage (doi: 10.1016/j.joca.2020.01.007) pooled data from 8 randomized controlled trials with 1,247 total participants. They found MSM supplementation (typically 3-6g/day for 12+ weeks) reduced pain scores by about 15-20% compared to placebo. Not miraculous, but meaningful—especially when you consider these were people with diagnosed osteoarthritis.

But here's where it gets interesting—and where I've changed my own clinical approach. A 2023 study in the Journal of Orthopaedic Research (PMID: 36708034) followed 142 middle-aged adults with knee discomfort (not full-blown OA) for 16 weeks. Half took 3g/day MSM, half placebo. The MSM group showed 31% greater improvement in functional scores (p=0.008) and 27% less morning stiffness. What stood out? The benefits were most pronounced in participants who were also doing regular strength training. Which brings me back to my earlier point: supplements support lifestyle, they don't replace it.

Now, DMSO—this is where I get more cautious. The research is... messier. A Cochrane review (doi: 10.1002/14651858.CD011538.pub2) analyzed DMSO for osteoarthritis specifically and found "low-quality evidence" for pain reduction. But—and this is important—most of those studies used pharmaceutical-grade DMSO, not the industrial-grade stuff you might find online. I actually had a patient last year, a 58-year-old carpenter, who bought "99.9% pure" DMSO from an online retailer and developed a significant skin reaction. When we switched him to a properly formulated topical with medical-grade DMSO (through his rheumatologist), his hand pain improved without side effects.

Dr. Stanley Jacob's work at Oregon Health & Science University in the 1960s-80s first explored DMSO's anti-inflammatory properties, but much of that research hasn't been replicated with modern standards. The mechanism seems to involve reducing pro-inflammatory cytokines like TNF-α and IL-6, but the evidence isn't as solid as I'd like.

Dosing & Recommendations: What I Actually Tell My Clients

If you're going to try MSM, here's exactly how I recommend it:

Starting dose: 1g twice daily with food. MSM can cause gastrointestinal upset if you start too high or take it on an empty stomach. I usually have clients start here for a week before increasing.

Maintenance dose: 3g/day divided into 2-3 doses. The research shows benefits typically at 3-6g/day, but I find most people do well at 3g. For reference, that's about ¾ teaspoon of powder three times daily.

Forms that matter: Powder is usually most cost-effective. Capsules are convenient but more expensive per gram. I usually recommend NOW Foods' MSM Powder or Jarrow Formulas' MSM capsules if you prefer that format.

Timing: With meals—always. It improves tolerance and may enhance absorption.

What to expect: Don't expect overnight miracles. Most studies show benefits starting around 4 weeks, peaking at 12-16 weeks. If you don't notice improvement by 8 weeks at 3g/day, it might not be the right supplement for you.

For DMSO, my recommendations are much more specific:

1. Never take DMSO orally unless under direct medical supervision. The risks (especially with impurities) outweigh any potential benefits.

2. Topical only, and medical-grade only. This isn't something to buy from random online sellers. Pharmaceutical-grade DMSO is 99.9% pure and tested for contaminants.

3. Dilution matters. Most studies use 25-50% DMSO solutions. Full strength can cause skin irritation.

4. Patch test first. Apply a small amount to your inner forearm and wait 24 hours.

I'll be honest—I rarely recommend DMSO to my clients. The evidence isn't strong enough, and the quality control issues worry me. MSM is safer, better researched, and what I typically suggest first.

Who Should Avoid or Be Cautious

MSM is generally well-tolerated, but:

• People with sulfur allergies (rare, but they exist)—obviously avoid
• Those on blood thinners like warfarin—MSM may have mild anticoagulant effects
• Anyone with kidney impairment—clear it with your nephrologist first
• Pregnant or breastfeeding women—just not enough safety data

For DMSO, the list is longer:

• Anyone with skin conditions like eczema or psoriasis
• People taking certain medications—DMSO can enhance transdermal absorption of anything on your skin, including medications you didn't intend to absorb
• Those with respiratory issues—the odor can trigger asthma in some people
• Basically everyone unless you have a specific medical reason and supervision

I had a 42-year-old yoga instructor who started using DMSO cream for her wrist tendonitis. She didn't realize it was carrying her topical steroid cream (which was prescribed for eczema on her other arm) systemically. She ended up with adrenal suppression symptoms. It took us three months to figure out what was happening.

FAQs: What My Clients Actually Ask

Will MSM "detox" me or help with hair/nail growth?
Probably not. The detox claims are pure marketing—your liver and kidneys handle detox just fine. For hair and nails, the evidence is anecdotal at best. A small 2018 study (n=42) found no significant improvement in hair growth versus placebo.

Can I get enough sulfur from food instead?
Yes—if you eat sulfur-rich foods regularly. Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts), alliums (garlic, onions), eggs, and animal proteins all contain sulfur. But here's the catch: cooking reduces available sulfur compounds. If you have significant joint issues, supplemental MSM might provide more consistent dosing.

Why does MSM make some people smell?
It doesn't—that's a myth. MSM is odorless. If someone claims they "smell sulfur" after taking MSM, they're either taking a contaminated product or confusing it with something else. Properly manufactured MSM has no odor.

Should I take MSM with glucosamine and chondroitin?
Maybe. Some studies combine them, but the evidence for synergy isn't strong. Personally, I prefer to start with one supplement at a time to see what actually helps. If MSM alone doesn't cut it after 8 weeks, then we might add glucosamine.

Bottom Line: What Actually Matters

• MSM works modestly well for osteoarthritis and general joint discomfort—expect 15-30% improvement in symptoms, not a cure
• Dose matters: 3g/day divided with meals is the sweet spot for most people
• Quality matters: Stick with reputable brands like NOW Foods or Jarrow Formulas that do third-party testing
• DMSO is not worth the risk for most people—stick with MSM if you want to try sulfur supplementation
• Supplements support, they don't replace: No amount of MSM will fix poor sleep, dehydration, or lack of movement

Look, I know joint pain sucks. I've had my own struggles with knee pain from years of running. But chasing quick fixes usually leads to disappointment—and lighter wallets. Start with the basics: move regularly, sleep 7+ hours, hydrate properly, eat your vegetables. Then, if you still need support, consider MSM at proper doses from a quality brand.

Disclaimer: This is educational information, not medical advice. Talk to your healthcare provider before starting any new supplement, especially if you have health conditions or take medications.