Chondroitin, Glucosamine, MSM And Other Supplements: Facts & Truth
Chondroitin, Glucosamine, MSM, Hyaluronic Acid , these are just some of the most common dietary supplements for arthritis.
"Patented components that will regenerate your joints"
"Say goodbye to joint pain and see your skin regain its youthful appearance"
"Lubricates your joints, eliminates pain and improves movement in everyday activities"
These are some of the claims, more or less, often made by companies selling these supplements. But is there actually any truth behind the huge marketing hype?
When patients hear and read ads like these they come to their doctor, not surprisingly, with printed web pages, snippets ads and plenty of questions. The desire to find a miracle cure for their reduced mobility and arthritic pain is understandable. Many consumers wonder if there is a product on the market that their doctor has ignored. Unfortunately, patients are very willing to believe “evidence” provided by an athlete, a presenter or an unknown sufferer, and equally reluctant to accept the scientific evidence.
Why are these claims allowed: The asterisk syndrome
The US Food and Drug Administration (FDA) classifies dietary supplements as a subcategory of 'food'. This gives manufacturers more freedom and less supervision compared to drug companies. This leads to what some call the asterisk syndrome. When the manufacturer declares some amazing properties on a product an asterisk is typically included. You have probably seen something like the following statement in many supplements:
"These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, cure or prevent any disease. "
Below we will examine some of the most common supplements used for arthritis:
- Hyaluronic Acid
- Omega-3 Fatty Acids
- Shark Cartilage
Glucosamine is a key component of cartilage, mucosal, and synovial fluid. It can be manufactured in the laboratory, but commercial production is often made from the exoskeletons of lobsters, crabs, shrimps, and other sea creatures. It can be found in a variety of formulations, usually as glucosamine sulfate, but also as glucosamine hydrochloride and N-acetyl glucosamine.
The safety of glucosamine is generally considered to be good and is supported by several studies. However, the same cannot be said about efficacy.
For example, a meta-analysis of randomized placebo-controlled clinical trials from January 1980 to March 2002 found glucosamine to have "very significant efficacy" for all markers. However, another study on 1,583 people with symptomatic knee osteoarthritis which randomly selected the patients to receive glucosamine, chondroitin, a combination of glucosamine and chondroitin, celecoxib, or placebo for 24 weeks has a different opinion. In this case, the overall rate of response to glucosamine, chondroitin, and the combination was not found to be significantly better than placebo.
As you can see, the results are mixed!.
The side effects from glucosamine are all rare and mild. They might include include gastrointestinal symptoms such as constipation, diarrhea, gas, heartburn, and nausea. Glucosamine sulfate has also been associated with somnolence and headache.
The effects of glucosamine on lactating or pregnant women have not been studied enough so it’s better to avoid it if you are one.
Another thing to note is that glucosamine raises blood sugar levels. Although studies of glucosamine in patients with diabetes are unclear, it is believed that higher doses may prompt the pancreas to produce less insulin, so caution and medical consult is advised.
Like glucosamine, chondroitin is another key component of cartilage. Chondroitin can be manufactured synthetically, but is usually extracted from bovine and shark cartilage. It is believed to promote the production of new cartilage and to delay the destruction of the existing one, and has also been linked to aid in lubrication of the joints by drawing water from surrounding tissues into the joints. But all this of course is just the theory.
Participants in some studies have reported overall pain reduction and improvement of movement when taking chondroitin, although it is not uncommon for participants to take chondroitin along with pain killers or other conventional treatments for arthritis, so the true extent of the effectiveness of chondroitin remains unclear. Moreover, some studies seem to indicate that chondroitin should be taken up to four months before the benefits become apparent.
A 24-week trial on 279 patients found no significant difference between chondroitin and placebo regarding the primary criteria of effectiveness of the substance (pain in daily activities and the Lequesne index). The supplement did show however some effectiveness in the secondary criteria of pain.
A meta-analysis of glucosamine and chondroitin in a double-blind, randomized, placebo-controlled trial lasting 4 weeks or more, which took place from 1966-1999, showed that both supplements have moderate to great results.
However, when only the high-quality and larger studies are taken account, the effectiveness is reduced or zeroed.
Again, we see mixed results here!
The side effects of chondroitin are rare and may include hair loss and minor gastrointestinal upset. The effects of chondroitin in nursing or pregnant women have not been studied enough so better avoid it if you belong to this group!
Since chondroitin can reduce the blood's ability to clot, it should not be taken with aspirin, antiplatelets or anticoagulant drugs.
Given that glucosamine and chondroitin are both components of cartilage, we often see them combined in one product. The effectiveness of these combined products is unclear, although some patients with moderate to severe pain may experience some benefits. Whether this is due to placebo or real improvement is debatable.
Methylsulfonylmethane (MSM) has been proposed as a potential treatment for a variety of conditions ranging from osteoarthritis to stress and snoring. Unfortunately, very few clinical studies have examined the effectiveness of the supplement for osteoarthritis. It appears that MSM helps provide the sulfur which is lacking in many diets, but the evidence for this is inadequate at best.
A randomized, double-blind, placebo-controlled pilot trial of 50 patients that was conducted over 12 weeks found that the MSM produced significant decreases in pain and physical disability in the WOMAC scale, along with noticeable improvement in stiffness and overall symptoms.
Unfortunately, there is still no long term data on the efficacy and safety of MSM. However, initial results seem promising.
Omega-3 fatty acids
Omega-3 fatty acids from fish and other sea animals are often promoted as a treatment for arthritis, cardiovascular disease, and cholesterol. Today, there is little clinical evidence to support claims that omega-3 fatty acids can help in the fight against arthritis.
Because omega-3 fatty acids are derived from fish, they should be avoided by people with allergies to seafood.
Oral hyaluronic acid
Hyaluronic acid is a constituent of synovial fluid and is typically injected directly in the affected joint(s) to provide relief in end-stage osteoarthritis. Several manufacturers have started to produce oral forms, but clinical data on the efficacy of oral hyaluronic acid in the treatment of arthritis is simply put...lacking.
Shark cartilage has been advertised as a cure for all kinds of diseases and recently as a treatment for both rheumatoid arthritis and osteoarthritis. Although it contains chondroitin, there is again no evidence that taking a shark cartilage supplement actually helps.
Furthermore, no studies have been conducted to determine if the shark cartilage has any serious or long-term side effects.
The first thing to have in mind is that high-quality and large studies for the aforementioned substances are few. As of today, there is positive clinical data only for glucosamine, chondroitin and MSM. For this reason, it’s better if you take a supplement that combines two or more of these ingredients in one. Nutriplex is a good and cost-effective option if you are looking for a combined supplement.
For adults, the dose of glucosamine should be 1500mg ,of Chondroitin up 1250mg and for MSM 500 mg.
The rest of the supplements although safe have not yet been shown to be effective. Since they are considered to have no side effects, you have nothing to lose by giving them a try for a few months if you can afford them.
Remember to consult a doctor for any possible interactions with drugs that you already take.
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- Pavelká K, Gatterová J, Olejarová M: Glucosamine sulfate use and delay of progression of knee osteoarthritis: A 3-year, randomized, placebo-controlled, double-blind study. Arch IntMed 2002; 162(18):2113-2123
- American Academy of Orthopaedic Surgeons: Clinical Practice Guideline for Treatment of Osteoarthritis of the knee. Rosemont, IL; 2008.
- Reginster JY, Deroisy R, Rovati LC, et al: Long-term effects of glucosamine sulfate on osteoarthritis progression: A randomised, placebo-controlled trial. Lancet 2001; 357 (9252):251-256.
- Block JA, Oegema TR, Sandy JD, Plaas A: The effects of oral glucosamine on joint health: Is a change in research approach needed? Osteoarthritis and Cartilage 2010; 18(1):1-5.
- Laverty S, Sandy JD, Celeste C, et al: Synovial fluid levels and serum pharmokinetics in large animal model following treatment with oral glucosamine at clinically relevant doses. Arth & Rheum 2005; 52(1)181-191.
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