Kristen Philipkoski CONSUMER HEALTH INTERACTIVEBelow: • What is it good for? • How does it work? • How safe is it? • How is it taken?
For many years, veterinarians routinely gave glucosamine to racehorses to help preserve their joints over years of pounding the track. Now scientists are studying whether glucosamine, a compound that your body uses to make cartilage, can help people as well. European researchers have been studying whether taking glucosamine in supplement form can help relieve arthritis pain and rebuild eroded cartilage for 40 years. Now doctors in the United States are paying attention. In 1997 a sports physician wrote The Arthritis Cure, a book touting the benefits of glucosamine when taken with another compound, chondroitin. What is it good for? There are three salt forms (types) of glucosamine: Glucosamine sulfate, glucosamine hydrochloride and n-acetyl glucosamine. Glucosamine sulfate is the best studied of the three. A number of human studies found glucosamine sulfate reduced pain and improved function in people with knee osteoarthritis. In some studies it worked as well as non-steroidal anti-inflammatory drugs (NSAIDs). At least two studies found it helped maintain knee cartilage, something NSAIDs don't do. However, one study found it didn't help a group of older, heavy men who had knee osteoarthritis for more than ten years. There is limited evidence from human trials that glucosamine sulfate may help with osteoarthritis in other joints. Glucosamine hydrochloride did not reduce pain in one 8-week study of people with knee osteoarthritis. A combination of glucosamine hydrochloride, chondroitin sulfate and manganese reduced knee osteoarthritis pain in two human studies. But it is unclear if the benefit was from one, two or all three ingredients. N-acetyl glucosamine has not been studied in human osteoarthritis. How does it work? The theory is that people with arthritis may not produce enough glucosamine, and that taking glucosamine supplements might help restore the cartilage that has eroded away between arthritic joints. In one study, researchers traced radioactively labeled glucosamine in the body and found that joint cartilage was indeed absorbing it. Some researchers speculate that the sulfate portion of glucosamine sulfate may be important for its anti-arthritis effects. How safe is it? In studies, glucosamine rarely caused side effects, and then only mild ones such as nausea, diarrhea, constipation, and heartburn. However, no studies of glucosamine on pregnant women, children, and the very elderly have been done, so those populations should avoid glucosamine unless it is recommended by a doctor. Researchers speculate that glucosamine may be less risky than NSAIDs, which can cause stomach bleeding and even liver or kidney damage with long-term use. Glucosamine sulfate has been used safely in human studies lasting up to three years. Some glucosamine products are made from the shells of shellfish, so people with shellfish allergy should talk with their doctor before trying it. Also, evidence suggests that glucosamine may cause insulin resistance, so people with diabetes should talk with their doctor before using glucosamine. How is it taken? There are many glucosamine products available containing one or more of the three salt forms. Look for products that contain only glucosamine sulfate, the salt form shown to help knee osteoarthritis in people. A typical dose is 500 milligrams (mg) three times daily, or 1500 mg once daily. It takes a while to see a benefit from glucosamine, but if you haven't noticed any improvement in three months, ask your doctor whether it is worth continuing. One combination product, Cosamin DS (containing glucosamine hydrochloride, chondroitin sulfate and manganese) seems to help reduce knee arthritis pain. Keep in mind, the government doesn't regulate supplements as strictly as it does drugs, so quality and potency can vary from product to product. In rare cases, products may be contaminated with undesirable substances. Ask a pharmacist or naturopath to recommend a reputable brand.
Further Resources Varro E. Tyler, PhD. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Pharmaceutical Products Press, 1994. Andrew Weil, MD. Natural Health, Natural Medicine. Houghton Mifflin, 1995, 1998.
References Jellin JM, Gregory P, Batz F, Hitchens K, et al. Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. Stockton, CA: Therapeutic Research Faculty; http://www.naturaldatabase.com
Reginster JY, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001;357(9252):251-56.
Pavelka K, et al. Glucosamine sulfate as an osteoarthritis disease modification agent: a confirmatory, long-term, randomized, placebo-controlled, independent study. European Congress of Rheumatology, Prague, Czech Republic, June 13-16, 2001; Abstract OP0052.
Rindone JP, et al. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. West J Med 2000;172(2):91-94.
Houpt JB, et al. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol 1999;26(11):2423-30.
Leffler Ct, et al. Glucosamine, chondroitin and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med 1999;164(2):85-91.
Das A Jr, Hammad TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage 2000;8(5):343-50.
Hoffler LJ, et al. Sulfate could mediate the therapeutic effect of glucosamine sulfate. Metabolism 2001;50(7):767-770.
Carol J. Henderson, PhD, RD, Dietary Outcomes in Osteoarthritis Disease Management
http://www.arthritis.org/research/bulletin/vol52no12/glucosamine.asp
Reviewed by Forrest Batz, Pharm.D., an assistant clinical professor at UCSF's school of pharmacy and a consultant in natural medicines based in Santa Rosa, California.
Last updated January 8, 2009
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