Research Update on Glucosamine and Chondroitin - 2004
Douglas Andersen, DC, DACBSP, CCN
very interesting studies with clinical implications
It has been a few years since I wrote about glucosamine and chondroitin.
At that time, ivory tower academics in the United States were less than
impressed (in this author's opinion) with some very impressive research
from our friends across the Atlantic. That did not stop the alternative
community from keeping an open mind, and it did not prevent people in
pain from giving glucosamine and chondroitin a try.
In the last decade, we have learned the following about glucosamine
works for most people with mild to moderate arthritis.
2. Not every brand is bioavailable or contains what is claimed on the
label. This is especially true of chondroitin sulfate.
3. There are both slow and faster responders.
4. If there is no change in 90 days, assuming proper dosing and product
purity, the patient is likely a nonresponder.
This month, let's review some recent studies on glucosamine and chondroitin.
(For an easy-to-understand biochemical background on glucosamine and chondroitin,
please see "Glucosamine,
Part I" in the May 18, 1998 issue; "Glucosamine,
Part II," in the June 15, 1998 issue; and "Glucosamine,
Part III," in the July 13, 1998 issue.
usually shy away from animal studies, but this one is worth mentioning.
In this case, researchers found that the metabolic response of aged cartilage
to glucosamine was much better than young tissue.1
2. In a six-month study of 72 people with mild to moderate osteoarthritis
of the knee, and 21 people with severe osteoarthritis of the knee, subjects
were given either 2,000 mg of glucosamine hydrochloride, 1,600 mg of chondroitin
sulfate and 300 mg of manganese ascorbate, or a placebo.
Results after six months:
|G + C + Mn
with severe osteoarthritis, the improvement was not statistically significant.2
a large study, 212 people took either 1,500 mg a day of glucosamine sulfate
or a placebo. After five years, 177 were available for follow-up (glucosamine
- 91; placebo - 86). Joint space narrowing of the knees was 0.29 mm in
the glucosamine group and 0.69 mm in the placebo group.3
4. Type-II diabetic patients in a double-blind, placebo-controlled, randomized
trial received either a daily dose of 1,500 mg per day of glucosamine
hydrochloride and 1,200 mg per day of chondroitin sulfate, or a placebo.
After 90 days, the researchers determined that glucosamine hydrochloride
and chondroitin sulfate did not alter glucose metabolism in type-II diabetics.
This included glycosylated hemoglobin A1c, which is an important marker
of elevated glucose.4
5. In a study of 37 men and 13 women with a mean of age of 42 years and
suffering from nonspecific knee pain, 2,000 mg of glucosamine hydrochloride
or a placebo preparation was given. After 90 days, 88% of those taking
glucosamine and 17% of those taking placebo reported a reduction of "regular"
6. Thirty-four United States Navy Diving and Special Forces team members
with chronic lower back pain and knee pain were studied. X-rays showed
degenerative joint disease in the low back and knees of all subjects.
One group received 1,500 mg a day of glucosamine hydrochloride, 1,200
mg of chondroitin sulfate, and 228 mg a day of manganese ascorbate for
four months. The other group took a placebo preparation. After four months,
knee symptoms in the glucosamine and chondroitin group were reduced by
16% compared to placebo. There was no effect, positive or negative, for
pain in the lumbar spine.6 (Note: Although I have
patients with spinal arthritis who swear by glucosamine and chondroitin,
in blind studies, the response of the spine has been unimpressive compared
to the extremities.)
7. I have been skeptical of topical glucosamine and chondroitin, and have
not recommended it to my patients or doctors who write or call. This final
study involved 30 (15 + 15) men and women with a mean age of 62. It lasted
eight weeks and compared a cream that contained 50 mg of chondroitin sulfate
per gram, 30 mg of glucosamine sulfate per gram, 140 mg of shark cartilage
per gram, 32 mg of camphor per gram, and 90 mg of peppermint oil per gram
to a placebo cream.
At four weeks, the glucosamine and chondroitin group had slightly less
pain than the placebo group. At eight weeks, the glucosamine and chondroitin
group continued to show improvement, although the rate of improvement
in the second four weeks was 40% less than in the initial four weeks.
The authors calculated a transdermal absorption rate of approximately
30%. This equated to approximately 225 mg of chondroitin sulfate and 90
mg of glucosamine sulfate delivered dermally each day. Although the improvement
was slight, it was statistically significant.7
information may be useful for patients who are unable to tolerate oral
glucosamine and chondroitin. I am looking forward to larger studies using
topical glucosamine and chondroitin and will report on them in this column,
regardless of the results.
L. Glucosamine and chondroitin sulfate: Biological response modifiers
of chondrocytes under simulated conditions of joint stress. Osteoarthritis
2. Das A. Jr., Hammad TA. Efficacy of a combination of glucosamine hydrochloride,
low molecular weight sodium chondroitin sulfate and manganese ascorbate
in the management of knee osteoarthritis. Osteoarthritis Cartilage September
3. Walsh N. Glucosamine provides long-lasting effect on OA. Family Practice
News, Jan. 1, 2004;22.
4. Scroggie DA, Albright A, Harris MD. The effect of glucosamine-chondroitin
supplementation on glycosylated hemoglobin levels in patients with type
2 diabetes mellitus: Placebo-controlled, double-blinded, randomized clinical
trial. Arch Intern Med, July 14, 2003;163(13):1587-1590.
5. Braham R, Dawson B, Goodman C. The effect of glucosamine supplementation
on people experiencing regular knee pain. Br J Sports Med 2003;37: 45-49.
6. Leffler CT, Philippi AF, 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 February 1999;164(2):85-91.
7. Cohen M, Wolfe R, et al. A randomized, double-blind, placebo-controlled
trial of a topical cream containing glucosamine sulfate, chondroitin sulfate,
and camphor for osteoarthritis of the knee. J Rheumatol 2003;30:523-528.
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