Critics, or sceptics, argue that glucosamine adherents have an ostentatious pitch: that the nutritional supplement has ‘the unique ability’ to provide pain relief and help regenerate damaged tissue in joints. They ask: is this a well-orchestrated, or subtle marketing gimmick, or pitch — one you should run after and take? Some also refer to glucosamine as nothing short of the ‘Gingko’ of osteoarthritis therapy — a popular ‘natural’ remedy. This is not without reason. In a survey of 2,146 primary care physicians and rheumatologists, and a group of patients, conducted by Arthritis Today, 34 per cent with the disorder rated glucosamine as their favourite alternative to over-the-counter [OTC] conventional pain medications. As a matter of fact, physicians and therapists rated its utility higher — with 45 per cent preferring to call glucosamine their ‘supplement’ of choice.
Yet, not everyone is impressed with the beneficial effects of glucosamine. A section of rheumatologists [specialists in joint disorders] and researchers remains unconvinced and adheres to one quip: that there have been no long-term clinical studies of the supplement in human beings. They also extend their cynicism to the fact that since glucosamine is a nutritional supplement, and, therefore, not regulated by the Food and Drug Administration [FDA], in the US, for instance — the regulation, of course, is not relevant, elsewhere — there can be no certainty, in quantifiable, measurable terms, regarding its potency or purity. Proponents don’t agree — and, for good reasons.
Basic Building Block
Glucosamine is the basic building block for proteoglycans. Proteoglycans act like sponge to retain water so essential for vibrant joint function. In simple terms, when glucose, or sugar, and an amino acid, or protein building block, are combined they form glucosamine. Nature has endowed our body to manufacture its own glucosamine. This is one reason why, in osteoarthritis where there is a definitive depletion, every ‘ounce’ of glucosamine supply, as some therapists contend, can bring about a ‘pound’ of difference to your joint health.
The reason is simple. Glucosamine helps ‘compose’ cartilage in joints; it is also needed for the formation of blood vessels, bone, ligaments, nails, skin, synovial fluid, and tendons, aside from mucous secretions of our digestive tract. More importantly, glucosamine is needed by our body to make chondroitin. When taken orally in capsule, or tablet form, glucosamine is absorbed from the gastro-intestinal [GI] tract quickly and almost fully [90 per cent]. Once absorbed, the body sends the bulk of the ‘wrapped up’ compound to areas of cartilage — to build new and healthy cartilage.
The growing interest worldwide in glucosamine [pronounced, glue-koe-sah-meen] and chondroitin is not new. That glucosamine was synthesised more than 100 years ago may be news to most of us; what may also be news is that researchers first got its ‘clue,’ in the mid-1950s: that the substance could play a pivotal, or adjuvant, role in the management of osteoarthritis. The first uncontrolled studies were, of course, not meticulous — if not totally flawed. They also invited scepticism for ‘positive’ results — as a consequence of ‘fanciful’ thinking by physicians and therapists and their patients — when no conclusive proof was verifiable, or replicable. The idea may not have changed much today, although research studies in several countries, aside from the US, have showed that glucosamine really helps joint health. This has spawned the ‘New Collagen Era.’ What’s more, it has also given enough impetus for further studies.
Chondroitin
Chondroitin [pronounced, kon-droy-tin], or chondroitin sulphate, to use its technical name, is quite like glucosamine. It is made within the body. It is also an essential component of cartilage and other connective tissues. It belongs to a group of compounds called glycosaminoglycans. Chondroitin was first identified in the 1940s, as a component of cartilage. Its early research was confined to animals — to observe, or evaluate, possible results of its application in human joint health. As studies progressed, research on animals showed its ability to increasing proteoglycans production. This culminated in clinical trials on human subjects. The results have been consistent: chondroitin relieves joint pain, improves mobility, reduces swelling in the affected part, and also one’s ‘over-reliance’ on non-steroidal anti-inflammatory drugs [NSAIDs].
As for glucosamine, as studies suggest, can help rebuild cartilage affected by osteoarthritis. When a capsule or tablet of the supplement is ingested, most of it ends up in the tissues of our joints. When glucosamine enters the chondrocytes — the cartilage-building assembly line inside the cartilage tissue — it is utilised to form new proteoglycans, which are responsible for healthy joint function. This, by itself, is a vital contribution, because in osteoarthritis the body’s resources to manufacture adequate levels of new proteoglycans are compromised.
‘Ringing in the new, and ringing out the old,’ is nature’s maxim in the cell-replacement process. This process is regulated and facilitated by enzymes that mortify the old cells. When such a breakdown occurs more quickly, or rapidly, and replacement does not keep pace with it, just as quickly, the outcome is imminent — frail cartilage. This situation calls for supplemental glucosamine intake. Glucosamine not only stalls the enzymatic destruction of proteoglycans, it also provides anti-inflammatory response in the affected joint.
The Evidence
According to Dr Timothy E McAlindon, MD, MPH, Chief, Division of Rheumatology and Professor, Tufts University School of Medicine, US, and author of a topical study reviewing the scientific evidence of glucosamine and chondroitin, “The jury is still out on whether this works.” Nevertheless, Dr McAlindon and his colleagues agree that there is convincing evidence that “some glucosamine products” may actually help reduce inflammation and alleviate pain of osteoarthritis. But, what they are not clear about is whether glucosamine [and, chondroitin] can also ‘freeze’ and ‘turnaround’ the disorder.
Other researchers maintain that a number of documented benefits may be exaggerated — or, that the conclusions of several studies were ‘inclined’ and methodologically inconsistent. Some say, it is just the opposite. Their raison d’être: just one of the major 15 studies, researchers had, at one point of time, and thoroughly looked into, was sponsored by manufacturers and/or pharmaceutical companies.
In an article published in Osteoarthritis and Cartilage, principal investigator Dr Amal K Das, MD, found that glucosamine/chondroitin sulphate dietary supplement [Cosamin DS] was effective in the management of joint pain in the knee. The randomised, placebo-controlled, peer-reviewed, clinical study was conducted on a group of patients, involving a combination of glucosamine and chondroitin sulphate and using a standardised index to measuring joint pain. In the study, glucosamine/chondroitin supplements showed significant improvement in the management of joint pain in the knee. The response rate was 52 per cent in comparison to a 28 per cent response rate in the placebo [dummy pill] group.
Balancing Act
The two supplements, glucosamine and chondroitin, as some dispassionate clinicians say, restore the joint modelling process and elevate balance in treatable cases — balance holds the key to stopping osteoarthritis from running wild. Besides, the duo props up the proteoglycans’ building, or re-building, ability, aside from chondrocytes. In a major [double-blind] study, published in The Lancet, researchers from four countries found convincing evidence that glucosamine had the ability to prevent osteoarthritis progression in a group of study subjects. A double-blind study is a clinical trial in which neither the study staff nor the participants know which participants are receiving the experimental substance, and who are receiving a placebo, or another therapy. Double-blind trials are thought to produce objective results, since the researchers’ and volunteers’ expectations about the experimental substance do not affect the outcome.
The study was no quick clinical ‘mug-shot’ at glucosamine; it was based on sound scientific principles and adhered to the strictest norms. This isn’t all. Neither the patients nor medical professionals had the ‘ghost of an idea,’ or clue, as to who among the trial group was taking glucosamine and/or placebo. The study was also without bias, because there is always the prospect of detracting from the merits of any benefit as having emerged due to ‘straight-line’ thinking, or contemplation.
The patients in the study were all afflicted with osteoarthritis of the knee joint. Exactly half of the individuals took 1,500 mg of glucosamine sulphate per day; the other half was given placebo. The supplement ‘diet’ went on for a period of three years and the end-result was encouraging. Pain dropped by 20-25 per cent among the subjects taking glucosamine; symptoms increased by 10 per cent in the placebo group. X-ray studies also substantiated the progress — the glucosamine group showed no deterioration in their knee-joint abnormalities, whereas the placebo group continued to experience worsening abnormalities.
This was a ground-breaking outcome even though it did not necessarily excite researchers who had already concurred that glucosamine was able to help the cartilage rebuild itself — with the aid of scanned electron micrographs. The experience was similar with patients taking chondroitin [800 mg per day] supplements. When an adult group of patients, with thinning cartilage, was given oral doses of chondroitin and placebo, for a period of one year, the cartilage in the former not only stopped thinning, but also improved its thickness. Besides this, the group showed adequate improvement in pain and joint mobility, among other parameters.
The real shot in the arm for the two supplements emerged, thanks to the ‘reception’ they received from Drs Jason Theodosakis, Brian Adderly, and Barry Fox’s landmark book, The Arthritis Cure. The book contended, in clear terms, the medical fact that glucosamine and chondroitin, in conjunction, could halt, reverse, and even offer a ‘cure’ for osteoarthritis. Soon enough, the two supplements became as big a name as the newest, or latest, blockbuster movie from Hollywood, or Bollywood.
It is, of course, simple for one to go overboard in view of the fact that the two supplements seem to break new ground with every realistic trial. It would also be, at the same time, no exaggeration to say that some highly qualified and respected researchers have gone on record, despite their usual scientific inclination for discretion, and recommend that it would be useful to try the two-supplement-option prior to the use of aspirin, NSAIDs, or surgery — albeit the duo is no ‘fool-proof’ panacea for all osteoarthritis patients.
