Glucosamine
sulfate supplement - Glucosamine and Chondroitin information
by Ray Sahelian, M.D.
Glucosamine supplements have become quite popular in the past
few years. Many people take glucosamine and chondroitin supplements for joint
health. Do these supplements work? Do they reduce symptoms of
osteoarthritis? Does glucosamine have side effects? I review the
latest research regarding the benefits and side effects of glucosamine
sulfate and glucosamine hydrochloride. I also review the benefit of combining glucosamine and
chondroitin supplements.
What is glucosamine?
Glucosamine is made from the combination of a sugar - hence the first part
of the name glucos(e) - and an amine, which is a derivative of ammonia containing nitrogen
(N) and hydrogen (H) atoms.
Glucosamine is found largely in cartilage and
plays an important role in its health and resiliency. As we age, we lose some of the
glucosamine and other substances in cartilage. This can lead to thinning of cartilage and
the onset and progression of osteoarthritis. It is important to note that there are a
number of important substances within cartilage and glucosamine ingestion, by itself,
should not be viewed as the complete answer. In fact, not all studies show
glucosamine to be helpful by itself. Some studies show glucosamine is more likely to be effective
when taken with other nutrients such as MSM and chondroitin.
Joint Power Rx with glucosamine
chondroitin, MSM, and other nutrients
Formulated by Ray Sahelian, M.D.
Glucosamine and chondroitin alone
may not be enough for full joint protection. This powerful formula includes glucosamine, chondroitin, MSM, and several additional herbal extracts
and nutrients that play a role in joint health.
Joint Power
Rx Supplement Facts:
Ingredients
in Joint Power Rx:
Glucosamine sulfate,
Chondroitin sulfate,
MSM,
CMO complex,
Boswellia serrata extract,
Curcumin, Cat's
claw extract, Devil's claw extract,
Grape-Seed extract, and Sea Cucumber.
Click here to buy Glucosamine Sulfate supplement, Joint Power Rx with
glucosamine, Chondroitin supplement, Diet Rx appetite suppressant, or to
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a discussion of several studies on various supplements and natural medicine topics, and
their practical interpretation by Ray Sahelian, M.D. We discuss glucosamine,
arthritis, chondroitin, msm and
osteoarthritis research.
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Hyaluronic-Acid
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Glucosamine
Sulfate 500 mg
Glucosamine
sulfate is a naturally occurring amino sugar. Amino sugars are key constituents
of larger compounds called glycosaminoglycans and glycoproteins, which enable
cells in tissues to hold together. They are necessary for the construction and
maintenance of virtually all connective tissues and lubricating fluids in the
body - tendons, ligaments, cartilage, bone matrix, skin, joint fluid, intestinal
lining, and mucous membranes.
Glucosamine sulfate is complexed with potassium chloride to enhance stability.
Glucosamine supplement Facts:
Glucosamine sulfate 500 mg * (as glucosamine sulfate potassium chloride)
Suggested Use: One glucosamine sulfate tablet, three times daily, or 3 glucosamine
sulfate tablets once daily.
* Glucosamine sulfate daily value not established
Glucosamine and chondroitin study
The effect of glucosamine and/or chondroitin sulfate on the progression of
knee osteoarthritis: A report from the glucosamine / chondroitin arthritis
intervention trial.
Arthritis Rheum. 2008 Oct. Sawitzke AD, Shi H, Finco MF, Dunlop
DD, Bingham CO 3rd, Harris CL, Singer NG, Bradley JD, Silver D, Jackson
CG, Lane NE, Oddis CV, Wolfe F, Lisse J, Furst DE, Reda DJ, Moskowitz RW,
Williams HJ, Clegg DO. University of Utah School of Medicine, Salt Lake
City.
This study was undertaken to evaluate the effect of glucosamine and
chondroitin sulfate, alone or in combination, as well as celecoxib and
placebo on progressive loss of joint space width in patients with knee
osteoarthritis.
A 24-month, double-blind, placebo-controlled study, conducted at 9 sites
in the United States as part of the Glucosamine / Chondroitin Arthritis
Intervention Trial (GAIT), enrolled 572 patients with knee
osteoarthritis
who satisfied radiographic criteria (Kellgren /
Lawrence [K/L] grade 2 or grade 3 changes and joint space width of at
least 2 mm at baseline). Patients with primarily lateral compartment
narrowing at any time point were excluded. Patients who had been
randomized to 1 of the 5 groups in the GAIT continued to receive
glucosamine 500 mg 3 times daily, CS 400 mg 3 times daily, the combination
of glucosamine and CS, celecoxib 200 mg daily, or placebo over 24 months.
The minimum medial tibiofemoral joint space width was measured at
baseline, 12 months, and 24 months. The primary outcome measure was the
mean change in joint space width from baseline. The mean joint space width
loss at 2 years in knees with osteoarthritis in the placebo group,
adjusted for design and clinical factors, was 0.166 mm. No statistically
significant difference in mean joint space width loss was observed in any
treatment group compared with the placebo group. Treatment effects on K/L
grade 2 knees, but not on K/L grade 3 knees, showed a trend toward
improvement relative to the placebo group. The power of the study was
diminished by the limited sample size, variance of joint space width
measurement, and a smaller than expected loss in joint space width. At 2
years, no treatment achieved a predefined threshold of clinically
important difference in joint space width loss as compared with placebo.
However, knees with K/L grade 2 radiographic
osteoarthritis
appeared to have the greatest potential for modification by these
treatments.
My comments: According to the way I read this study, there was a
small improvement in those who had a grade 2 level of joint space
narrowing before the study started. In other words, those whose knee
osteoarthritis was not very bad had some benefit from the glucosamine
chondroitin supplement use. I wonder if the study had gone on a few more
years the changes would have been more apparent. Also, I wonder if results
would be different if all the capsules were taken at one time in the
morning on an empty stomach. Many people may forget to take their pills
three times a day.
Benefit of glucoamine and osteoarthritis
Glucosamine sulfate has hardly been evaluated in conditions other than osteoarthritis. Hence it is not
very clear whether glucosamine is helpful in those with damage
to cartilage or joints due to musculoskeletal injuries. Glucosamine appears to help rebuild
cartilage in osteoarthritis patients, but it is unlikely that it would help joints where
the cartilage has been surgically removed.
Similarly, glucosamine has not been
fully tested in autoimmune diseases involving joints such as lupus and rheumatoid arthritis. Those with artificial joints are not likely to be helped by glucosamine
since they have no cartilage to rebuild. The positive effects of glucosamine in
reducing joint pain are often noticed within a few weeks.
Over the years there have been dozens of studies regarding the
benefits of glucosamine for osteoarthritis. Some have shown clear
benefits, whereas others did not indicate glucosamine to be helpful. There
is no consensus in the medical establishment whether glucosamine is
beneficial. Current drugs used for osteoarthritis, such as COX-2
inhibitors and acetaminophen, actually cause harm and side effects. At the
least, glucosamine supplement use does not seem to harm the body. There is
a good possibility that the benefits of glucosamine are enhanced when used
together with other supplements such as chondroitin, MSM, and others.
Q. Does glucosamine benefit those with rheumatoid arthritis?
A. We doubt glucosamine would benefit patients with rheumatoid
arthritis since the joint damage is due to an autoimmune reaction.
However, we can't be sure until studies are completed.
Glucosamine sulfate of
glucosamine hydrochloride?
Glucosamine is available as glucosamine sulfate or glucosamine hydrochloride ( glucosamine
hcl ). A review of
the scientific literature shows glucosamine is likely to be helpful for many
patients with osteoarthritis. Almost all of
the earlier studies done with glucosamine have used the sulfate form since a company in Europe
funded the studies. However, the hydrochloride form has
been used by doctors for many years and it seems to work well, too. The hydrochloride
form is cheaper.
Glucosamine liquid
Various supplement companies now make glucosamine available in liquid
form. Glucosamine liquid may be appropriate for those who are not able to
swallow capsules.
Q. Would you discuss the benefits or lack
thereof from taking glucosamine sulfate in liquid form rather than as a
pill? There is quite a bit of controversy going on regarding glucosamine
liquid versus glucosamine pills. Thanks from a fan of your newsletter,
A. As of September 2008, I have not seen studies with glucosamine
liquid compared to glucosamine pills. Therefore, I can't say whether
glucosamine liquid is any more or less effective than glucosamine pills.
Glucosamine and allergies - where does glucosamine come
from?
Those who are allergic to sulfates may take glucosamine hydrochloride and not glucosamine
sulfate, and they should avoid chondroitin sulfate. Glucosamine is derived from shrimp,
oyster and crab shells and chondroitin is derived from cartilage of cows, pigs, and
sharks. There is no synthetically made glucosamine on the market.
Glucosamine allergy
for those allergic to shrimp
Do shrimp-allergic individuals tolerate shrimp-derived glucosamine?
Clin Exp Allergy. 2006 Nov;36(11):1457-61. Tulane University Health Sciences
Center, Department of Clinical Immunology, Allergy, and Rheumatology, New
Orleans, LA.
There is concern that shrimp allergic individuals may react to glucosamine containing
products as shrimp shells are a major source of glucosamine used for human
consumption. The purpose of this study was to determine whether shrimp allergic
individuals can tolerate therapeutic doses of glucosamine. Subjects with a
history of shrimp allergy were recruited. Fifteen
subjects with positive skin tests to shrimp and an ImmunoCAP class level of two
or greater were selected for a double-blind placebo-controlled food challenge
using glucosamine chondroitin tablets containing 1,500 mg of synthetically
produced (control) or shrimp-derived glucosamine. No allergies were noticed. This study demonstrates that glucosamine supplements from specific
manufacturers do not contain clinically relevant levels of shrimp allergen and
therefore appear to pose no threat to shrimp-allergic individuals.
Combining glucosamine supplement with drugs
Glucosamine supplements may be taken together with acetaminophen or NSAIDs such
as ibuprofen and naproxen. After glucosamine supplements start working in a few weeks, hopefully the
dose of the drugs can be reduced or eliminated. I am not aware of glucosamine interacting
with other medicines. It appears that glucosamine, chondroitin and other
arthritis herbs are safer than the pain medicines.
Glucosamine side effects - long term safety
Based on our current understanding, glucosamine has few side effects, and can be taken for
extended periods, months and years. Thus far, after being on the market for quite a number
of years, there have not been any reports in the medical literature of any significant
glucosamine side effects. However, as with most nutrients
and medicines, long term effects are not clearly known.
Timing of glucosamine supplement ingestion
It's difficult to say when the best time or frequency to take a glucosamine
supplement, whether with or
without food, but a good option is to take glucosamine before meals. All 1,500 mg a day
can be taken at one time or split in two or three divided doses throughout the day.
Pregnancy and
glucosamine supplement use
It is best
pregnant women not take a glucosamine supplement until more is known about this interaction.
Fortunately, most pregnant women are not at an age where they would have
osteoarthritis.
Glucosamine and diabetes
Glucosamine supplements do not seem to have a significant effect on blood sugar
or have a negative impact in patients with diabetes. The usual dose of glucosamine sulfate, one or two grams a day, is minimal as a sugar source
compared to the amounts of carbohydrates found in the foods we consume. Studies do indicate that glucosamine is safe for patients with diabetes.
In a study published in Archives of Internal Medicine, 38 elderly patients
with type two diabetes were divided into two groups. The first diabetes group took 1500 mg
of glucosamine supplement a day combined with 1200 mg of chondroitin sulfate. Chondroitin
is another supplement often used in combination with glucosamine to treat
osteoarthritis. The other group took placebo pills. Two-thirds of the dose was
taken in the morning and one-third in the evening. The study lasted for 90 days.
Blood studies were done to evaluate blood sugar levels, and also levels of
hemoglobin A1c, a specific blood marker than can tell us average blood sugar
levels over long periods of time. There was no statistically significant rise in
hemoglobin A1c levels in those who took a glucosamine supplement.
Patients with
diabetes are often at risk from toxic effects from many of the current
treatments for osteoarthritis, such as the NSAIDs ibuprofen and naprosyn.
These medicines cause stomach ulcers and kidney damage if used for prolonged
periods. Glucosamine sulfate provides a safe and natural alternative.
The effect of glucosamine chondroitin supplementation on glycosylated
hemoglobin levels in patients with type 2 diabetes mellitus: a
placebo-controlled, double-blinded, randomized clinical trial.
Arch Intern Med. 2004 Apr 12;164(7):807.
Scroggie DA, Albright A, Harris MD. Wilford Hall Medical Center, Lackland Air
Force Base, Lackland, TX
With increasing use of glucosamine supplements for the
treatment of osteoarthritis, there is increasing concern in the medical
community about possible side effects. The present study was undertaken to
determine whether glucosamine supplementation altered hemoglobin A1c
concentrations in patients with well-controlled diabetes mellitus. Patients were typically
elderly patients being treated with 1 or 2 drugs for blood sugar control. In
daily doses for 90 days, patients received either placebo or a combination of
1500 mg of glucosamine hydrochloride with 1200 mg of chondroitin sulfate (Cosamin
DS; Nutramax Laboratories Inc, Edgewood, Md). There were 4 withdrawals
from the glucosamine hydrochloride treated group. Three were related to comorbidities
(myocardial infarction, congestive heart failure, and atrial fibrillation) and 1
to a possible side effect (excessive flatus). No other patient reported any
side effects of glucosamine therapy, and no patient had any change in their
diabetes management. Mean hemoglobin A1c concentrations were not significantly
different between groups prior to glucosamine therapy. Posttreatment hemoglobin
A1c concentrations were not significantly different between groups. This study demonstrates that oral glucosamine supplementation does
not result in clinically significant alterations in glucose metabolism in
patients with type 2 diabetes mellitus.
Effect of glucosamine supplementation on fasting and
non-fasting plasma glucose and serum insulin concentrations in healthy
individuals.
Osteoarthritis Cartilage. 2004 Jun;12(6):506-11.
To test the hypothesis that glucose intolerance does not occur when
healthy adults consume normal, recommended dosages of glucosamine sulfate.
Healthy adults ingested 1500 mg of glucosamine sulfate or placebo (double blind)
each day for 12 weeks. Three-hour oral glucose tolerance tests were performed using 75 g of dextrose. These occurred before the
start of supplementation, at 6 weeks, and at the completion of supplementation
(12 weeks). There were no significant differences between fasted levels
of serum insulin or blood glucose. Glucosamine sulfate supplementation did not
alter serum insulin or plasma glucose during the oral glucose tolerance tests. The data
suggests that glucosamine supplementation, with normal recommended dosages, does
not cause glucose intolerance in healthy adults.
Glucosamine sulfate
and cholesterol levels
Apparently glucosamine does not seem to influence blood levels of
cholesterol.
The effect of glucosamine sulfate on the blood levels of cholesterol or
triglycerides
Ugeskr Laeger. 2007 Jan 29;169(5):407-10. Østergaard K, Hviid T,
Hyllested-Winge JL. Slidgigtinstituttet A/S, Ishøj.
This study was conducted in order to determine if glucosamine sulfate
taken by patients as treatment for chronic joint pain influences the fasting
blood levels of cholesterol and triglycerides. A study performed with parallel groups of 66 patients over 40 years of
age with joint pain of long duration receiving either recommend dosage
(1500 mg per day) of glucosamine sulfate or placebo. No significant differences
between the glucosamine sulfate group and the placebo group with respect
to cholesterol and triglycerides were observed. There were no differences
between the treatment groups with respect to side-effects. This study
demonstrates that glucosamine sulfate does not significantly influence
blood levels of cholesterol or triglycerides.
Glucosamine and chondroitin
If glucosamine itself is not helpful in relieving arthritic symptoms, it may be combined
with chondroitin and other
nutrients. Alternatively, glucosamine and chondroitin can be started together
with several other nutrients such as MSM and CMO.
Q. Would a glucosamine chondroitin
supplement offer benefits that go beyond a glucosamine supplement by itself?
A. Based on my evaluation of studies, I believe that the addition of chondroitin to
a glucosamine supplement regimen does provide additional benefits.
Glucosamine and chondroitin slow
bone loss in osteoarthritis
In experiments with bone tissue samples from patients with knee arthritis,
chondroitin and glucosamine affect osteoblasts in a manner that slows
arthritis related bone loss. Bone remodeling is a continuous process in which
existing bone is broken down and replaced with new bone tissue. Osteoarthritis
occurs when the cartilage cushioning the joints begins to break down; but there
is also a breakdown in the bone underneath the cartilage. This bone loss is
related to an imbalance in the activity of the cells that break down bone (osteoclasts)
and cells that build bone (osteoblasts). When osteoblast cells taken from
patients undergoing knee-joint replacement for severe knee arthritis are exposed
to chondroitin, glucosamine or a combination of the two affected osteoblast
activity in a way that may inhibit bone breakdown. Arthritis Research & Therapy,
online November 9, 2007.
Glucosamine and chondroitin for
knee and hip osteoarthritis
Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip
osteoarthritis.
Drugs Aging. 2007;24(7):573-80. WHO Collaborating Center for Public Health
Aspect of Osteoarticular Disorders, University of Liège, Liege, Belgium.
This review evaluates published studies of the effect of glucosamine and chondroitin sulfate preparations on the progression of knee or hip
osteoarthritis. Despite multiple double-blind, controlled clinical trials of the
use of glucosamine and chondroitin sulfate in osteoarthritis, controversy
regarding the efficacy of these agents with respect to symptomatic improvement
remains. Several potential confounders, including placebo response, use of
prescription medicines versus over-the-counter pills or food supplements, or use
of glucosamine sulfate versus glucosamine hydrochloride, may have relevance when
attempting to interpret the seemingly contradictory results of different
clinical trials. On
the basis of the results of recent trials and
meta-analyses, we can conclude that glucosamine sulfate (but not glucosamine
hydrochloride) and chondroitin sulfate have small-to-moderate symptomatic
efficacy in osteoarthritis, although this is still debated.
Glucosamine and MSM work better together for arthritis
We all know the benefits of glucosamine and chondroitin for arthritis.
Now it seems there's another nutrient that could be helpful in combination
with glucosamine. This nutrient is known as MSM -- which stands for
Methylsulfonylmethane. In the June 2004 issue of the journal Clinical Drug
Investigations, scientists report that although the individual supplements did
improve pain and swelling in arthritic joints, the combined therapy was
more effective than the single nutrients in reducing symptoms and
improving the function of joints. In a clinical trial conducted at Nizam's
Institute of Medical Sciences in Hyderabad, India, 118 patients with mild
to moderate osteoarthritis were treated three times daily with either 500
milligrams of glucosamine, 500 milligrams of MSM, a
combination of both, or an inactive placebo. After 12 weeks of treatment,
the average pain score had fallen from 1.74 to 0.65 in the glucosamine only
group. In MSM only participants, it fell from 1.53 to 0.74. However, in
the combination group, it fell from 1.7 to 0.36.
Comments: It would seem reasonable for those with arthritis
to take this combination. The dose of glucosamine has been established to
be 500 mg 3 times a day. We still don't know enough about MSM to determine
whether lesser amounts than 500 mg three times a day would still be
effective.
Can glucosamine pills be absorbed from the stomach
and end up in cartilage?
Yes. After oral administration of glucosamine sulfate, 90% is absorbed.
(Sulfate means that the glucosamine is attached to a sulfur and oxygen atoms.)
In a study done in Italy, two healthy male volunteers were given 250 mg of
oral glucosamine sulfate, tagged with radioactive carbon 14 as a tracer, in the morning on an
empty stomach. The radioactive glucosamine sulfate was found an hour later in blood and then
later in other tissues. The researchers state, "Glucosamine sulfate very rapidly diffuses in most
tissues and organs and that it has a special tropism (attraction) for articular
tissue (cartilage) and for bone." These volunteers were also given glucosamine sulfate intravenously (IV) and intramuscularly (IM). The amount of glucosamine sulfate in blood after
oral administration was only a quarter of the amount available by IV and IM.
Therefore oral administration is effective, but not as good as IV or IM. When
oral glucosamine sulfate is absorbed, it first goes to the liver where a large portion gets
broken down into smaller molecules such as carbon dioxide, urea and water.
Glucosamine
supplement
availability
Most often glucosamine is sold as glucosamine sulfate or glucosamine
hydrochloride. Very frequently glucosamine and chondroitin are combined
together. Lately, more products are being sold with glucosamine, chondrotin, and
MSM. Furthermore, more recently, these last three nutrients have been combined
with other herbs and nutrients that play a role in joint health including CMO,
curcumin, boswellia, etc.
Glucosamine supplements are also sold as a liquid or powder. You
will also find glucosamine formulas for dogs.
Q. Would a glucosamine tablet absorb
better than a glucosamine capsule?
A. I doubt there would be much of a clinical difference.
Does every patient
with osteoarthritis benefit from glucosamine and chondroitin?
No. Based on my clinical experience, the results of published studies,
and discussions with doctors who use glucosamine supplements, I would estimate that about a
third of patients notice a moderate to significant improvement while another
third notice slight improvement. Other patients are disappointed. The reasons
why some individuals do not respond adequately are not known. We should keep in
mind that the biochemistry of cartilage tissue is complicated and many factors
besides glucosamine and chondroitin are involved in the process of cartilage
formation. It is possible that additional nutrients and herbs taken along may
benefit those who do not respond to glucosamine and chondroitin alone.
How does glucosamine work?
Scientists still don't have all the answers, but they think glucosamine
stimulates the biosynthesis (production) of some proteoglycans, restores damaged
chondrocytes (cells of cartilage tissue), and has some antioxidant and anti-inflammatory
abilities. The anti-inflammatory abilities of glucosamine are much less than
NSAIDs and glucosamine is not known to have pain-killing abilities. Therefore,
users should not expect immediate relief of their symptoms.
Can I find
glucosamine in foods?
No food sources of glucosamine are known that would provide this nutrient
in the dosages required for arthritic relief. Hence, the best source of glucosamine is through taking supplements.
Is glucosamine
toxic?
We know that NSAIDs can cause stomach ulcers and bleeding. A 1991 study
published in the journal Drug Research showed glucosamine to be safe. When daily
oral doses of
glucosamine sulfate
up to 2700 mg/kg were given in the rat and 2100 mg/kg in the
dog for one year and six months, respectively, no anatomical lesions were found
in the gastrointestinal system or other organs. The dose given to the dogs would
be equivalent to 150,000 mg in a 70 kg human. Most of the recommended dosages
for patients with arthritis are about 500 mg three times a day. However, Italian
researchers have found that the LD50 (the lethal dose at which half of the
animals die) of
glucosamine sulfate
is 8000 mg/kg. In humans this would be equivalent to
ingesting over 500,000 mg at one time or 1,000 pills each containing 500 mg.
Glucosamine sulfate versus
acetaminophen
Glucosamine sulfate in the treatment of knee
osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study
using acetaminophen as a side comparator.
Arthritis Rheum. 2007 Feb;56(2):555-67. Rheumatology Department,
Fundación Jiménez Díaz-Capio, Madrid, Spain.
To assess the effects of the prescription formulation of glucosamine sulfate
(1,500 mg administered once daily) on the symptoms of knee osteoarthritis during a 6-month treatment course. Three hundred eighteen patients were enrolled
in this randomized, placebo-controlled, double-blind trial in which
acetaminophen, the currently preferred medication for symptomatic treatment of
osteoarthritis, was used as a side comparator. Patients were randomly assigned
to receive oral glucosamine sulfate 1,500 mg once daily, acetaminophen 3 gm/day,
or placebo. There were more responders to glucosamine sulfate (39%) and
acetaminophen (33%) than to placebo (21%). Safety was good, and was comparable
among groups. The findings of this study indicate that glucosamine
sulfate at the oral once-daily dosage of 1,500 mg is more effective than placebo
and more or as effective than acetaminophen in treating knee
osteoarthritis symptoms.
Will supplements help if I have a knee replacement?
Glucosamine and chondroitin help regrow cartilage. However, if you have
no cartilage left, these nutrients will not do any good to artificial knees.
They may help, though, with your other joints. The best option is to prevent the
joint from getting to a stage of destruction by using nutrients that help keep
cartilage tissue healthy.
Glucosamine and osteoarthritis research update
- some studies show benefit, others don't
In a 2006 study published in
the New England Journal of Medicine, glucosamine and chondroitin sulfate did
not provide significant relief from osteoarthritis pain among all participants.
However, a smaller subgroup of study participants with moderate-to-severe pain
showed significant relief with the combined supplements. Researchers led by
rheumatologist Daniel O. Clegg, MD, of the University of Utah, School of
Medicine, Salt Lake City, conducted the 4-year study known as the glucosamine
and chondroitin Arthritis Intervention Trial (GAIT) at 16 sites across the United
States. GAIT enrolled nearly 1,600 participants with documented osteoarthritis of
the knee. Participants were randomly assigned to receive one of five treatments
daily for 24 weeks: glucosamine alone (1,500 mg), chondroitin sulfate alone
(1,200 mg), glucosamine and chondroitin sulfate combined (same doses), a
placebo, or celecoxib (200 mg). The researchers found that
participants taking celecoxib experienced statistically significant pain relief versus placebo -- about 70 percent of those taking celecoxib versus
60% taking placebo had a 20% or greater pain reduction. For all participants,
there were no significant differences between the other treatments tested and
placebo. However, for participants in the moderate-to-severe pain subgroup,
glucosamine and chondroitin sulfate provided statistically significant
pain relief compared to placebo -- about 79% in this group had a 20% or greater
pain reduction compared to 54% for placebo. In the subgroup of participants with
mild pain, glucosamine and chondroitin sulfate together or alone did not provide
statistically significant relief compared to placebo. On entering the study, a
participant's level of pain was assessed as either mild or moderate to severe
using standard pain assessment tools and scales, such as the Western Ontario and
McMaster Universities Osteoarthritis Index (WOMAC). Of the 1,583 study
participants, 78% were in the mild pain subgroup and the other 22% were in the
moderate-to-severe pain subgroup. In addition to taking their daily
study treatment, participants could take up to 4,000 mg of acetaminophen daily
for pain, except for the 24 hours before they were assessed by study staff. Few
side effects from any of the treatments were reported.The GAIT team continues their research with a smaller study to
see whether glucosamine and chondroitin sulfate can alter the progression of
osteoarthritis, such as delaying the narrowing of the joint spaces.
Glucosamine, chondroitin
sulfate, and the two in combination for painful knee osteoarthritis.
N Engl J Med. 2006 Feb 23;354(8):795-808.
Glucosamine and chondroitin sulfate are used to treat osteoarthritis. The
multicenter, double-blind, placebo- and celecoxib-controlled glucosamine /
chondroitin Arthritis Intervention Trial (GAIT) evaluated their efficacy and
safety as a treatment for knee pain from osteoarthritis. We randomly assigned
1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of
glucosamine daily, 1200 mg of chondroitin sulfate daily, both glucosamine and
chondroitin sulfate, 200 mg of celecoxib daily, or placebo for 24 weeks. Up to
4000 mg of acetaminophen daily was allowed as rescue analgesia. The mean age of the patients was 59
years, and 64 percent were women. Overall, glucosamine and chondroitin sulfate
were not significantly better than placebo in reducing knee pain by 20 percent.
As compared with the rate of response to placebo (60 percent), the rate of
response to glucosamine was 3.9 percentage points higher, the rate of response
to chondroitin sulfate was 5.3 percentage points higher, and the rate of
response to combined treatment was 6.5 percentage points higher. The rate of
response in the celecoxib control group was 10 percentage points higher than
that in the placebo control group. For patients with moderate-to-severe pain at
baseline, the rate of response was significantly higher with combined therapy
than with placebo (79 percent vs. 54 percent). Glucosamine and chondroitin sulfate alone or in combination
did not reduce pain effectively in the overall group of patients with
osteoarthritis of the knee. The combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients
with moderate-to-severe knee pain.
Glucosamine supplements, while generally safe, are not effective in treating osteoarthritis of the knee. In the latest study, Dr. Tim McAlindon and colleagues from Tufts-New England Medical Center in Boston randomly assigned 205 adults with painful knee osteoarthritis to take glucosamine (1.5 grams per day) or a placebo for 12 weeks. Ninety-three participants in each group completed the trial. At the end of the study there were no significant differences between glucosamine and placebo in terms of changes in pain scores. There were also no marked differences between glucosamine and placebo in terms of stiffness, physical function, and use of painkillers, the team reports in the American Journal of Medicine.
Initial results of two highly anticipated clinical trials involving the use of glucosamine and / or chondroitin by individuals experiencing pain from osteoarthritis were announced Sept, 2005 in abstract form, and demonstrate strong support for use of both by osteoarthritis patients to relieve pain. Both studies, which were presented at a conference of the American College of Rheumatology, add further support to the growing scientific literature demonstrating the benefits of glucosamine and chondroitin for joint health. The multi-centered Glucosamine / chondroitin Arthritis Intervention Trial (GAIT) conducted by NIH involved nearly 1,500 osteoarthritis patients who were supplemented with 1,500 mg/day glucosamine hydrochloride and/or 1,200 mg/day chondroitin sulfate vs. 200 mg/day of the common prescription pain medication celecoxib (Celebrex) or placebo for 24 weeks. Preliminary results indicate that both celecoxib and glucosamine - chondroitin combination significantly reduced knee pain compared to placebo, and that all treatments were well tolerated by the study subjects. These findings were mirrored by the preliminary results of another multi-centered clinical study, the European-sponsored Glucosamine Unum in Die Efficacy (GUIDE) Trial, which compared the effect of glucosamine sulfate (1,500 mg/day) vs. acetaminophen (3,000 mg/day) or placebo over 24 weeks on various pain and mobility indices of osteoarthritis. Researchers reported that glucosamine sulfate was more effective than acetaminophen, and concluded that "glucosamine sulfate…might be the preferred symptomatic medication in knee osteoarthritis," and "There were no differences among groups in safety."
Randomized, double-blind, placebo-controlled
glucosamine discontinuation trial in knee osteoarthritis.
Arthritis Rheum. 2004 Oct 15;51(5):738-45.
To assess the efficacy of glucosamine sulfate in knee osteoarthritis. A 6-month, randomized, double-blind, placebo-controlled glucosamine discontinuation trial was conducted in 137 current users of
glucosamine with knee osteoarthritis who had experienced at least moderate improvement in
knee pain after starting glucosamine. Study medication dosage was equivalent to
the dosage of glucosamine taken prior to the study (maximum 1,500 mg/day).
Follow up continued for 6 months or until disease flare, whichever occurred
first. Disease flare was seen in 28 (42%)
of 66 placebo patients and 32 (45%) of 71 glucosamine patients. At final study visit, acetaminophen was used in 27% and 21% of placebo
and glucosamine patients, respectively, nonsteroidal antiinflammatory
drugs were used in 29% and 30%, and both were used in 20% and 21%. No differences were found in severity of disease flare or other
secondary outcomes between placebo and glucosamine patients. In
patients with knee osteoarthritis with at least moderate subjective improvement with prior glucosamine use, this study provides no evidence of symptomatic benefit from
continued use of glucosamine sulfate.
Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women
with knee osteoarthritis: evidence from two 3-year studies.
Menopause. 2004 Mar-Apr;11(2):138-43.
Bruyere O. WHO Collaborating Center for Public Health Aspect of Osteoarticular
Disorders, Liege, Belgium.
To investigate the effect of glucosamine sulfate on long-term
symptoms and structure progression in postmenopausal women with knee
osteoarthritis. This study consisted of a preplanned combination of
two three-year, randomized, placebo-controlled, prospective, independent studies
evaluating the effect of glucosamine sulfate on symptoms and structure
modification in osteoarthritis and post-hoc analysis of the results obtained in
postmenopausal women with knee osteoarthritis. Minimal joint space width was assessed at
baseline and after 3 years from standing anteroposterior knee radiographs. Of 414 participants randomized in the two studies, 319 were postmenopausal
women. At baseline, glucosamine sulfate and placebo groups were comparable for
demographic and disease characteristics, both in the general population and in
the postmenopausal women subset. After 3 years, postmenopausal participants in
the glucosamine sulfate group showed no joint space narrowing, whereas participants in the
placebo group experienced a narrowing of -0.33 mm. Percent changes after 3 years
in the WOMAC index showed an improvement in the glucosamine sulfate group and a
trend for worsening in the placebo group. This analysis, focusing on
a large cohort of postmenopausal women, demonstrated for the first time that a
pharmacological intervention with glucosamine for osteoarthritis has a disease-modifying
effect in this particular population, the most frequently affected by knee
osteoarthritis.
The effect of glucosamine supplementation on people experiencing regular knee
pain.
Braham R. University of Western Australia, Crawley, Western Australia 6009. Br J
Sports Med. 2003 Feb;37(1):45-9; discussion 49.
The purpose of this study was to examine the effects of oral glucosamine supplements on the functional ability and degree of pain felt by
individuals who had regular knee pain, most likely due to previous articular
cartilage damage, and possibly osteoarthritis. Subjects were randomly
supplemented with either glucosamine or placebo (P) (lactose) for 12 weeks at a
dose of 2,000 mg per day. The clinical and functional test scores improved with time
but there were no significant differences between the two groups. The
questionnaire results also recorded a significant main effect for time, but the glucosamine group was found to have significantly better
quality of life scores. On self report evaluations of changes across the 12 week supplementation
period, 88% of the glucosamine group reported some degree of improvement
in their knee pain versus only 17% in the placebo group.
These results suggest that glucosamine supplements can provide some degree
of pain relief and improved function in persons who experience regular knee
pain, which may be caused by prior cartilage injury and/or osteoarthritis. The
trends in the results also suggest that, at a dosage of 2,000 mg per day, the
majority of improvements are present after eight weeks.
NAG - N acetyl glucosamine
supplement
N-Acetyl glucosamine, or N Acetyl D glucosamine is a form of glucosamine and a
precursor to hyaluronic acid. There is early research testing n acetyl
glucosamine as a potential helpful treatment for the symptoms arising from
ulcerative colitis and Crohn's disease. Much less research has been done with n
acetyl glucosamine than with glucosamine supplements.
Glucosamine supplement emails -
newer emails are added at the bottom
Q. I have begun taking glucosamine sulfate and found
it to be very rewarding toward back pain. I have spinal stenosis and with all
the cut-backs on pain medication, it was hard to get my doctor to prescribe
something for the pain I endured for over 3 months. I tried glucosamine
sulfate and received great benefits. My question is: Do I continue to take this
as an ongoing medication or do I take it only when symptoms are present?
A. As a rule, glucosamine is
slow acting and needs to be taken for a prolonged periods to be effective.
Although it is possible to take breaks for a while and then return to using glucosamine
again.
Q. This sounds
like a joke but it's not. Perhaps a month or two after I began to take a
glucosamine and chondroitin supplement to protect against knee pain, I began to
notice that my penis, which had always assumed a straight position in the erect
state, was developing a noticeable bend. (If I had said I was taking the
supplement for joint pain, then you really would have been inclined to toss this
one out.) Over the next month or two, the bend became more pronounced and I was
on the verge of consulting a urologist to look into the possibility of
Peyronie's Disease, a condition that apparently afflicts our ex-president
Clinton and can I understand, interfere with sex if it progresses too far. The
only change in my daily routine I could think of during this time was the
addition of the glucosamine and chondroitin to my usual vitamins and mineral
regimen. I dropped the supplement and over
the next couple of months the bend in the penis gradually disappeared. Perhaps
it was a coincidence (although I don't think so).
A. This is the first time I have
heard of glucosamine and chondroitin involved in this after several years of
looking into these combinations. I don't know what to say. I think it's
possible but just as likely it could have been a coincidence. Were there other ingredients in the formula or just glucosamine and
chondroitin? There's so little we know about the long term effects of
supplements and herbs that I keep any side effects as a possibility. I guess a
good way to find out for sure is to retake it and see what happens, since it
appears to be reversible on stopping... but i can see one's reluctance in this
trial when it comes to such an important member of the body :)
Q. I have a
brief question: Have you had anyone using either glucosamine alone or in
combination with chondroitin report that their total cholesterol increased? I
have a friend who discontinued taking the combination for that reason. I don't know how long she had been taking it.
A. It is unlikely that glucosamine and chondroitin have much
of an influence on cholesterol levels. Dietary changes are much more likely to
have led to the changes.
Q. I am a retired pathologist. My wife and I
have been taking the standard dose of glucosamine and chondroitin for 5 months
( age 78 years). Both of us have noted that our fingernails seem to grow faster
and be stronger than before. Our son (age 50) has noted the same, and he is a
guitar player who uses his nails as a pick. I have not found this effect in a
cursory exam of the net and thought you might be interested.
A. This is the first we have heard of glucosamine and chondroitin
having an influence on nail growth.
Q. Just wanted to comment on one of the emails
quoted on your glucosamine supplement page (the one from the retired pathologist
who noticed his nails growing faster). I've been taking glucosamine sulfate and
chondroitin for the last 2 years, to relieve bursitis of the wrists. I consider
myself 90% recovered, which is wonderful, but I've also discovered an unexpected
side effect. My fingernails, which have always been very thin and brittle, and
would flake off at the edges before they had a chance to grow, are now much
thicker and stopped flaking completely. I noticed this effect after taking the
supplement for about 2 months. I'm a 33 y/o female and for the first time in my
life I can wear long nails!! It's very exciting for me. Just thought you might
like to know.
A. Interesting, this is the second report we have had regarding the
influence of glucosamine and chondroitin on nail growth.
Q.
I am a 37 year old male who has been active all my
life. Last year I started having major middle back pains that even wiped me out when I
washed dishes in my home. Mowing the yard really did me in. I was an avid runner, worked
out 4 to 5 times a week, have 2 jobs. One at a desk, the other waiting tables in an
Italian restaurant. I have consistently taken Bayer aspirin to relieve the pain yet I knew it
didn't repair the problem.
Recently, in a health food store I saw a glucosamine chondroitin product and thought I would give it
a try. Never having taken any vitamins or supplements, I purchased the Joint
Power Rx joint formula. I have been on it for 3 weeks now. On Sunday, I mowed the yard, dug a one foot
deep and 15 foot long drainage trench, cleared about a 4x20 area of weeds with a hoe, and
later that evening, I went to the gym and waited tables for 4 hours. I know I was pushing it. Seriously when I got back home I cried because I felt
I had a lot of my physical strength back.
Q. I think your glucosamine site is very informative and I
found it very useful however, I have taken glucosamine for a while and thought I
knew a bit about it. I thought that 1500mg glucosamine sulfate daily is best for
most people. The 500 mg glucosamine product suggests 500mg to 1500mg (3 x 500mg
daily) but your Joint Power Rx product says 6000 mg (2 x 1500mg twice daily) or
9000mg (3 x 1500mg twice daily) for the first month. There is a big difference
between the lowest recommendation of 500mg glucosamine sulfate daily and the highest of 9000mg glucosamine daily on your two
products. Are you able to tell me which one is correct or which is optimal for
most people. Also the 500mg glucosamine says "as glucosamine sulfate potassium
chloride" which presumably means that it only provides around 375mg of actual
glucosamine sulfate? since the Joint Power Rx does not say this am I to assume
this is 1500 mg of actual glucosamine sulfate? Finally, the Joint Power Rx looks
like a comprehensive formula, but with such a lot of ingredients and a high dose
I am wondering what size the capsule is as I have difficulty swallowing larger
ones.
A. Joint Power Rx has 1,500 mg of glucosamine
sulfate per 4 capsules. This product has many other herbs and extracts and we
have great feedback, users are satisfied. Scientists still don't know how often
to take glucosamine for best results, once, twice, or three times a day.
Q. Can glucosamine sulfate be used as a preventative for
arthritis, joint problems, etc?
A. Not enough long term research has been done to know
the ideal age to start a glucosamine supplement and whether it's use will prevent or slow
arthritis or joint problems. However, thus far, glucosamine appears to be free
of major side effects.
Q. Quest - a vitamin company in Canada makes a
shellfish free glucosamine product. I have allergies and I
take this product every day now for over 2 years.
A. Thanks for letting us know. In June 2003, Cargill Acidulants began producing Regenasure glucosamine. Cargill Acidulants claims
Regenasure glucosamine is the only commercially available glucosamine product
not derived from shellfish. It wasn't clear from their website the source of
their glucosamine hydrochloride.
Q. I have purchased 3 containers of 60 CMO tablets, reference a book by Dr L Sands (Arthritis beaten today) in
the book he states that sea cucumber extract and time release glucosamine
sulphate is also required can you help.
A. There are many herbs or nutrients, besides CMO, that could
potentially help someone with joint health, many of them are found in Joint Power
Rx including sea cucumber and glucosamine. We have not seen any studies that
compare time release glucosamine sulfate to regular glucosamin sulfate, and
for the time being we think this is a marketing tactic.
Q. I have high cholesterol, does glucosamine sulfate
supplement use increase or decrease cholesterol levels?
A. Glucosamine sulfate supplement use does not influence blood
levels of cholesterol or triglycerides to any significant degree.
Q. My question is about about glucosamine and chondroitin. I would
like to know your opinion about its true benefit. I have been taking them
somewhat regularly. I would like to know if these supplements are a long term solution to
osteoarthritis, especially since my arthritis is not that serious. I thought
that since my arthritis is not very serious at all, then I could take the
glucosamine chondroitin combination, and my arthritis would remain in this
condition without getting worse.
A. It is difficult to predict what effect glucosamine and
chondroitin have in any one individual, but statistically, a good number of
people do find a benefit from the use of glucosamine chondroitin supplements.
Q. Does liquid glucosamine powder offer benefit for
arthritis more than an oral glucosamine supplement?
A. We have not seen any research comparing liquid glucosamine to
oral glucosamine pills. We doubt liquid glucosamine offers any advantages except
to those who have difficulty swallowing pills.
Q. You discuss glucosamine and diabetes. Do you know
whether glucosamine is safe for a person with liver disease?
A. We have not seen any research that indicates that glucosamine is
toxic to the liver and have not seen any research to indicate what would happen
if a person with liver disease took glucosamine for prolonged periods. As of
January of 2008, we have not seen any medical reports of liver damage from the
use of glucosamine supplements.
Q. Does the combination of glucosamine chondroitin msm benefit
more than glucosamine and chondroitin by themselves?
A. We have not seen human studies with the a glucosamine chondroitin
MSM combination. There is some early research that found glucosamine and msm
together offer more benefit. Therefore, it makes sense that the combination of
all three nutrients would work better.
This glucosamine page was last updated January 2008.