Glucosamine: Cure or Hoax?

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Category: Medications & Supplementation Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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So many patients ask me about Glucosamine: Does it work? Will it cure my arthritis? Is this the miracle we’ve been waiting for? Well, here are some answers.

As I explained in a previous article, cartilage is a living tissue that grows, breaks down and repairs itself, under normal circumstances. It can normally maintain an equal rate of decay and repair with the help of its only cell called "chondrocyte". Chondrocytes and extracellular matrix (70% water and 30% collagen and proteoglycans) form articular cartilage, which makes up 95% of our body tissue. Chondrocytes secrete and maintain the matrix, while the matrix in turn supplies the chondrocytes with an environment to perform their function and survive. Therefore, the importance of the matrix cannot be overstated.

In osteoarthritis (OA), there is a complex connection between chondrocytes and the matrix. The matrix is degraded and normal development is inhibited, therefore altering the functions of our cartilage.Excessive biochemical stress can cause an imbalance in the decay/repair process making chondrocytes unable to keep up with cumulative damage. This imbalance damages the cartilage, creating cracks, tiny fissures, and loss of density and elasticity. This process is what paves the way for the insidious development of osteoarthritis.

Currently there is no known cure for osteoarthritis, only symptom relief. Conventional treatment for osteoarthritis ideally aims to reduce pain and stiffness, improve the affected joint’s movement, and slow the progression of the disease. Weight loss and exercise are the first steps in managing OA. It is hoped that weight loss will reduce the amount of weight placed on the affected joints. Regular exercise will help maintain joint flexibility and ease the pain. Finally, drug treatments such as topical pain relievers, analgesics and NSAIDs, are usually offered to reduce joint pain and tenderness.

However, the ultimate goal in treating osteoarthritis is to not only decrease the symptoms but to be able to control the disease. This is why there is a real need for disease-modifying agents (DMARD) for the treatment of osteoarthritis to control the progression of this degenerative joint disease and not just its symptoms.

WHAT ABOUT HERBAL SUPPLEMENTS SUCH AS GLUCOSAMINE?

In vitro studies have demonstrated that Glucosamine stimulates the formation of proteoglycans and collagen by chondrocytes and increases the production of matrix. It is a chemically pure compound and is absorbed from the gastrointestinal tract and dispersed throughout the body, with a particular inclination for the articular cartilage.Due to this ability, Glucosamine has become an appealing treatment because it seems to provide a balance between OA’s decay and repair process, thus protecting the cartilage.

Glucosamine sulfate is virtually an unregulated herbal supplement that has found its way into our society, like bees to honey. Unlike prescription and over-the counter medication, which must pass rigorous testing to receive FDA approval before making it to market, Glucosamine and other herbal supplements can find their place on store shelves without scrutiny or approval from any regulatory board. As long as their product labels or advertisements do not make direct health claims such as “the cure for arthritis", they are not required to divulge a full list of ingredients, possible side effects, warnings on usage, guidelines for appropriate dosages or other directions for safe and effective use. In addition, due to the fact that no regulatory guidelines are available, there can be many variations in the quality and quantity of these supplements.

Current laws allow Glucosamine, as well as all dietary supplements to be sold to the consumer without efficacy, safety or standard manufacturing testing. In fact, manufacturers are allowed to make all sorts of claims for their products just short of saying that it is a cure.

As with so many other dietary supplements, too many unknowns exist regarding the safety and efficacy of Glucosamine. This is why a well-designed study, which includes a sufficient numbers of participants with similar features of osteoarthritis and a comparison of the two groups (one taking a standard medication and the other taking a substance being tested blindly (meaning patients taking a “placebo”) be conducted for at least one year by experienced researchers using objective measures and statistical techniques to determine if there is any improvement as the result of treatment. Unfortunately, few of these criteria were met in current Glucosamine studies.

WHAT IS A PLACEBO EFFECT?

The placebo effect is used to describe the phenomenon that cause 20% to 40% of people who unknowingly take a "sugar pill," or a substance with no medicinal content, to report improvement. Although the exact source of a placebo's power is unknown, experts attribute it to mind-body interaction. They suspect it may be linked to the hope and belief that the substance will work, and the powers of positive thinking.Unfortunately, this effect can create misleading information to the untrained eye. If a study proves that 40% of the participants had significant improvement after treatment, are the results really due to the drug or to the placebo?

IN CONCLUSION…

The information we have from a few quality studies highly suggest that Glucosamine is effective and at least as good as Ibuprofen for treating osteoarthritis. Taken orally, GS appears to be safe and studies have reported either very mild or no side effects. The dose most often recommended is 500 mg of Glucosamine sulfate three times daily; however, the scientific rationale for this dose is not available in the study. Glucosamine may be effective in decreasing the symptoms of osteoarthritis and some patients truly believe that it has helped them.

In 1999, the National Institute of Health (NIH) began an extensive study to determine the effects of Glucosamine and provide us with accurate information to about this possible supplement for osteoarthritis. However, until these results are available, we must exercise caution and realize that at this point, Glucosamine may be a good supplement, but not a miracle cure.

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