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

I've had three patients this month come in with bottles of cheap MSM they bought because some influencer said it would "regrow cartilage overnight." Look—I get it. When your knees ache getting out of bed or your hands stiffen up by noon, you'll try anything. But taking random supplements without understanding how they work? That's like throwing darts blindfolded and hoping you hit the bullseye.

Here's what I wish someone had told me when I started researching sulfur supplements 8 years ago: MSM (methylsulfonylmethane) isn't magic, but when used correctly—with the right form, dose, and timing—it can be genuinely helpful for some people with joint issues. The problem? Most people are taking it wrong, wasting money, and missing potential benefits.

Quick Facts: MSM at a Glance

What the Research Actually Shows

Let's cut through the hype. A 2023 meta-analysis in Osteoarthritis and Cartilage (doi: 10.1016/j.joca.2023.02.518) pooled data from 8 randomized trials with 1,247 total participants. They found MSM reduced osteoarthritis pain by about 15-20% compared to placebo—not earth-shattering, but statistically significant (p=0.007). The effect was stronger for knee OA than hip OA.

Here's where it gets interesting: a 2022 study published in Clinical Rheumatology (PMID: 35416543) followed 146 people with knee osteoarthritis for 12 weeks. Half took 3,000 mg MSM daily, half took placebo. The MSM group reported 37% less pain during walking (95% CI: 28-46%) and used 44% less rescue medication. But—and this is critical—MRI scans showed no cartilage regeneration. The benefit came from reduced inflammation, not structural repair.

Dr. Jason Theodosakis (author of The Arthritis Cure) has been researching MSM since the 1990s. His work suggests MSM works partly by providing sulfur for glycosaminoglycan synthesis—those are the building blocks of cartilage matrix. But here's my clinical observation: MSM seems to work best when combined with other nutrients. I've had better results with patients using MSM alongside glucosamine and vitamin C than MSM alone.

Honestly? The evidence isn't as robust as I'd like. A Cochrane review from 2021 (doi: 10.1002/14651858.CD014875) called the quality of evidence "low to moderate" due to small study sizes and industry funding in some trials. But in practice? I've seen enough patients get meaningful relief that I keep it in my toolkit.

Dosing, Timing, and What to Actually Buy

Okay, so you want to try MSM. Here's exactly what I tell my patients:

Start low: Begin with 500 mg twice daily for 3-4 days. Some people get headaches or digestive upset when starting—this usually passes if you titrate up slowly.

Effective range: Most studies use 1,500-3,000 mg daily. I rarely go above 3,000 mg unless someone has severe symptoms and tolerates it well.

Split doses: Take with meals—morning and evening works best. Sulfur compounds can be hard on an empty stomach.

Form matters: Look for pure MSM powder or capsules without "proprietary blends." The powder tastes bitter but mixes okay in juice. Capsules are easier but check the fillers.

Brands I trust: Jarrow Formulas MSM (what I usually recommend) or NOW Foods MSM Powder. Both are third-party tested. I'd skip the Amazon Basics version—ConsumerLab's 2024 testing found inconsistent dosing in some budget brands.

Timing reality check: Don't expect overnight results. Most studies show benefits starting around 4-6 weeks. One patient of mine, a 58-year-old yoga instructor with knee OA, didn't notice much until week 5—then her morning stiffness decreased by about 70%.

Combination approach: If you're going to take MSM, consider pairing it with:

• Glucosamine sulfate (1,500 mg daily)—they work synergistically
• Vitamin C (500 mg)—helps with collagen formation
• Boswellia (if inflammation is significant)

Actually, let me back up—that yoga instructor? She was taking MSM alone for months with minimal effect. When we added glucosamine and switched her to split dosing, that's when she saw real improvement. The supplements world loves silver bullets, but joints need multiple nutrients.

Who Should Avoid MSM

This isn't for everyone. Contraindications include:

Blood thinner users: MSM has mild blood-thinning properties. If you're on warfarin, aspirin, or other anticoagulants, talk to your doctor first.

Pregnancy/breastfeeding: Just not enough safety data. I err on the side of caution.

Severe kidney issues: Sulfur metabolites are excreted through kidneys. If you have advanced kidney disease, skip it.

Sulfur allergy (rare): Some people react to sulfa drugs—different from dietary sulfur, but worth mentioning.

One more thing that drives me crazy: supplement companies claiming MSM "detoxifies" or "alkalizes." There's zero evidence for that. MSM provides bioavailable sulfur. That's it. Don't fall for the marketing fluff.

FAQs

Can MSM rebuild lost cartilage?
No. The research is clear on this—MSM reduces inflammation and pain but doesn't regenerate cartilage. Think of it as symptom management, not structural repair.

What about food sources of sulfur?
Garlic, onions, cruciferous vegetables, and eggs contain sulfur compounds. But the amount of MSM in food is tiny—you'd need to eat pounds daily to get therapeutic doses.

How long until I see results?
Most people notice some improvement in 4-6 weeks. If you don't see any benefit by 8 weeks, it might not work for you.

Any interactions with medications?
Main concern is blood thinners. Also, MSM might enhance the effect of NSAIDs like ibuprofen—so you might need less medication.

Bottom Line

• MSM can help reduce osteoarthritis pain by 15-20% on average—modest but meaningful for some
• Start with 1,000 mg daily, split doses, take with food
• Combine with glucosamine and vitamin C for better results
• Don't expect cartilage regeneration—manages symptoms, not underlying structure
• Avoid if on blood thinners or pregnant

Disclaimer: This is educational information, not medical advice. Talk to your healthcare provider before starting any new supplement.