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By: Matthew Cavallero
Supplements have become a popular
alternative treatment for many different ailments. Studies
have shown that certain nutrients consumed at higher doses than
found in a normal diet may have significant therapeutic effects
against disease. Two such supplements are glucosamine and
chondroitin. These supplements have become very popular in
the treatment of osteoarthritis (OA) since The Arthritis Cure
went to print in 1997. In this book, Dr. Theodosakis states
that an effective arthritis-treating supplement must be able to
enhance cartilage and joint fluid synthesis, inhibit cartilage
breakdown, keep the joint space clear of fat deposits and reduce
joint pain and swelling. Although the perfect supplement
for treatment of OA has not yet been found, glucosamine and
chondroitin appear to address all of these factors.
While research shows that glucosamine and
chondroitin may delay the onset of OA and, for those who already
have OA, slow down disease progression and minimize symptoms, the
actions of both are poorly understood. Glucosamine
is a major part of cartilage because it is used by the cartilage
tissue to create proteoglycans, some of the proteins that make up
cartilage. This supplementation is advantageous in the
treatment of OA. In OA, the number of proteins produced is less
than those destroyed, resulting in a net loss of cartilage.
Chondroitin, on the other hand, is a sugar unit that attaches to
the enzymes that make proteoglycans. As a result, an
abundance of chondroitin in the body may also stimulate the
production of proteoglycans. Furthermore, because
proteoglycans are found in all connective tissue such as tendons
and ligaments, these supplements may also improve other
connective tissue ailments such as tendonitis, although there is
no research in these fields yet.
The effects of these two supplements have
been widely documented and vary from patient to patient. Glucosamine
may significantly reduce pain, improve movement, and prevent
joint-space narrowing by increasing proteoglycan synthesis and
decreasing breakdown enzyme activity for patients with OA.
Chondroitin is reported to protect existing cartilage from
breakdown with maintenance of joint cushioning effects. At
the same time, it encourages
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cartilage repair and has anti-inflammatory
effects.
Taking these two supplements over time may provide decreased pain
and swelling, which leads to a reduction of pain medication
needed and an increase in physical activity. A three-year
study conducted by researchers at the University of Liege in
Belgium showed that chondroitin slightly improved the joint space
in hips, knees, and fingers.
Much of the research regarding these supplements has been carried
out in Europe. American studies have only recently been
initiated. Currently, there is a 1000 patient, nationwide study
conducted by the National Institute of Health (NIH) underway to
show if these supplements alone or together truly can slow or
stop the loss of cartilage relating to OA. However, the
effects of these supplements on other forms of arthritis
(rheumatoid, gout, etc) have not yet been studied.
Glucosamine and chondroitin are typically
seen packaged together in one pill. Some companies also
sell each individually. The current recommendations are
that these two supplements should be taken together due to their
synergistic effect. However, if either supplement has to be
taken alone, chondroitin is preferred over glucosamine because it
has proven to be more effective. The suggested dosage for
glucosamine is 1500 mg per day taken over one to two doses, and
for chondroitin it is 1200 mg per day taken at the same time as
the glucosamine. It is preferable to take the doses with a
meal to increase absorption, and it will take at least two months
at this dosage before effects are noted. If this is
successful and there is pain relief, the amount taken can be
reduced, or you can speak to your health care provider about
possibly reducing your current pain medication. If you do
not experience any pain relief after four to six months of using
the supplements, you probably will not get any relief from this
treatment.
To date, no serious side effects have been
reported from the use of glucosamine or chondroitin. There
have been mild side effects such as indigestion, nausea,
increased intestinal gas, and softened stool. If you
experience any of these, trying a different brand may relieve
some or all of the symptoms.
Several precautions should be taken
regarding the use of these supplements. Glucosamine is
derived from the chitin in shells of crabs, lobster, and shrimp,
so if you are allergic to shellfish you may experience some
side effects. Chondroitin is usually derived from cow
cartilage, but some companies sell products made from shark
cartilage. Because the amounts of chondroitin vary greatly
in shark and may also contain heavy metals, any chondroitin
product made from shark cartilage should be avoided.
Certain people need to take extra safety
measures with these supplements. Children and women who are
or might be pregnant should not use these supplements because the
effects on children and fetuses are unknown. Diabetics
should check their blood sugar levels more often because
glucosamine is an amino sugar. Those on blood thinners
should be careful if taking chondroitin and should have their
blood-clotting prothrombin checked more often since chondroitin
may contain components similar to heparin and the combination
could increase the risk of bleeding.
A general precaution should be noted when
taking any supplement because they are not subject to the same
strict FDA regulations required of prescription and
non-prescription drugs. Caution must be taken when thinking of
purchasing a “value” brand. It is a fact that
some companies (either unintentionally or intentionally) skimp on
products and will have a lesser content than is advertised on the
label. This is particularly true of chondroitin because it
is expensive to derive. Since potency of chondroitin is
crucial, it is recommended to go with a reputable brand name
rather than the cheaper one.
There are health care providers who
recommend that their patients who have OA take glucosamine and
chondroitin. The risks and side effects are minimal with
these supplements, so even though there may not be concrete
evidence the supplements work, it can’t hurt to give them a
try. For additional information please visit the Arthritis
Foundation website at www.arthritis.org .