Glucosamine

Description:
Glucosamine is an aminopolysaccharide (a combination of an amino acid - glutamine and a sugar - glucose). Glucosamine is concentrated in joint cartilage where it is incorporated in longer chains known as glycosaminoglycans and finally into very large structures known as proteoglycans. The proteoglycans function to attract water into the joint space for lubrication of the cartilage during movement.

Claims:

Reverses osteoarthritis

Protects joints and tendons from injury

Decreases inflammation

Theory:
The principle behind glucosamine supplementation is that the glucosamine is delivered to the joint space and incorporated into proteoglycans of joint cartilage to maintain structure and repair damage. Glucosamine may also stimulate chondrocytes (cartilage cells) to begin producing healthy new cartilage matrix (both collagen and proteoglycans).

Scientific Support:
There are numerous European studies showing a clear benefit of glucosamine supplements for relief of joint pain and stiffness associated with arthritis. Many of the studies have been criticized for lack of scientific control, short duration and small size, but recent meta-analyses of the smaller studies have supported the beneficial role of glucosamine supplements as a safe and effective approach to treating osteoarthritis. In general 1-3 months of glucosamine supplementation seems to be more effective than a placebo and at least as effective as analgesic and non-steroidal anti-inflammatory drugs (NSAID), like acetaminophen and ibuprofen, in reducing the joint pain of osteoarthritis. Until more rigorous studies are conducted in the United States, the Arthritis Foundation has stated that it cannot recommend glucosamine supplements as a treatment for osteoarthritis, but this stand has not stopped the Foundation from accepting financial support from the producer of the best selling brand of glucosamine supplements on the market – Rexall Sundown’s Osteo-Bi-Flex. Perhaps the supplements with the best clinical substantiation are Dona from Rotta Labs and Cosamin from NutraMax Labs.

Safety:
Occasional symptoms of gastrointestinal discomfort have been noted, but no significant adverse effects have been noted with glucosamine supplementation. Although there have been no long-term safety studies conducted in humans, animal studies on glucosamine have found it to be non-toxic. Diabetics may want to exercise a degree of caution when using glucosamine supplements, as there have been several animal studies and one small human pilot study that have suggested an increase in blood sugar levels during regular glucosamine consumption (though most of the animal studies have used injections of glucosamine).

Value:
Glucosamine supplements tend to be among the more expensive products on the shelf. A one-month supply of capsules can range from $15 to well over $100. Because they have to be consumed for 1-3 months before any noticeable benefit is apparent, you may need to invest a significant amount of money before you realize any benefits. However, because arthritis pain is one of the most debilitating conditions, most people dealing with such pain would gladly invest a dollar or so per day in a supplement that relieved their discomfort and helped repair their damaged cartilage tissue. For people with existing chronic joint pain, glucosamine supplements are probably worth the significant dollar investment for the benefits that they deliver. For those individuals with intermittent joint pain or those with more mild joint stiffness, the high cost associated with glucosamine supplements may not be justified - and the money might be better spent on other more relevant supplements.

Dosage:
No dose-response studies have been conducted with glucosamine supplements. Virtually all oral supplementation studies on glucosamine have used 1500mg per day - usually in 3 divided doses of 500mg each. While this level appears to be an effective dose, there is no information to suggest that a higher does would work better or faster - or that a lower dose would be less effective. A common supplementation strategy, which can decrease the daily cost of supplements, is to consume 1500mg of glucosamine per day for the first 60-90 days of your regimen, followed by a reduced intake of 250-750mg per day as a "maintenance level." Following the initial 60-90 day period, dosage levels can be increased or decreased based on individual pain and stiffness levels.


References:
1. Barclay TS, Tsourounis C, McCart GM. Glucosamine. Ann Pharmacother. 1998 May;32(5):574-9.
2. da Camara CC, Dowless GV. Glucosamine sulfate for osteoarthritis. Ann Pharmacother. 1998 May;32(5):580-7.
3. Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999 May;25(2):379-95.
4. Delafuente JC. Glucosamine in the treatment of osteoarthritis. Rheum Dis Clin North Am. 2000 Feb;26(1):1-11.
5. Denham AC, Newton WP. Are glucosamine and chondroitin effective in treating osteoarthritis? J Fam Pract. 2000 Jun;49(6):571-2. 6. Donohoe M. Efficacy of glucosamine and chondroitin for treatment of osteoarthritis. JAMA. 2000 Sep 13;284(10):1241; discussion 1242.
7. Houpt JB, McMillan R, Wein C, Paget-Dellio SD. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol. 1999 Nov;26(11):2423-30.
8. Leeb BF, Schweitzer H, Montag K, Smolen JS. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000 Jan;27(1):205-11.
9. Leffler CT, Philippi AF, Leffler SG, Mosure JC, Kim PD. 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 Feb;164(2):85-91.
10. Mautone G. Efficacy of glucosamine and chondroitin for treatment of osteoarthritis. JAMA. 2000 Sep 13;284(10):1241; discussion 1242.
11. McAlindon TE, LaValley MP, Felson DT. Efficacy of glucosamine and chondroitin for treatment of osteoarthritis. JAMA. 2000 Sep 13;284(10):1241.
12. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000 Mar 15;283(11):1469-75.
13. Rindone JP, Hiller D, Collacott E, Nordhaugen N, Arriola G. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. West J Med. 2000 Feb;172(2):91-4.
14. Towheed TE, Anastassiades TP. Glucosamine and chondroitin for treating symptoms of osteoarthritis: evidence is widely touted but incomplete. JAMA. 2000 Mar 15;283(11):1483-4.

Added: September 8th 2002
Reviewer: SW Tech Staff
Related Link: Glucosamine
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