Two dietary supplements for relieving joint ache continue gaining popularity

The dietary supplements glucosamine and chondroitin have been gaining popularity among aging baby boomers. Often sold combined in pill form, these supplements are said to relieve achy knees and other joints.

Doctors were skeptical of the supplements’ effectiveness until the past few years, when a number of studies have provided at least anecdotal evidence that the supplements help osteoarthritis patients.

Referred to as the “Lancet glucosamine study,” a three-year study released in late 1999 by the American College of Rheumatology “suggests that glucosamine sulfate may be a possible disease modifying agent in osteoarthritis,” the report’s conclusion read.

Dr. Justin Green has a solo medical practice in Boulder and also is a member of the Orthopedic Professional Association, a practice based in Louisville and Boulder comprising five orthopedic surgeons. “Glucosamine has been shown to be potentially symptomatically helpful for patients with osteoarthritis, particularly of the knee,” he said.

While patients’ symptoms have decreased as a result of using the supplement, it is difficult to measure the supplement’s effect because cartilage is hard to X-ray, according to Green.

Most studies so far have examined the effects of glucosamine alone.

“There’s less evidence that chondroitin sulfate helps,´ said Dr. George Young. Young is board certified in rheumatology and practices at Boulder Medical Center. “Some studies say it may help. There may be benefits with chondroitin, but I tell people to take plain glucosamine.”

Newer studies may show otherwise. Evidence that chondroitin is effective “was shown in the most carefully controlled summary of all the placebo-controlled studies on glucosamine and chondroitin,´ said Dr. Jason Theodosakis. “A Journal of the American Medical Association article that reviewed all 15 double-blinded, placebo-controlled studies up to June 1999 revealed that the treatment effect for chondroitin was almost double that of glucosamine.”

Theodosakis serves as an assistant professor at the University of Arizona medical school and wrote best-sellers “The Arthritis Cure” and “Maximizing the Arthritis Cure.”

While it is believed that glucosamine and chondroitin improve the health of weight-bearing joints, no one is quite sure how.

“Glucosamine is one natural product that has some benefit,” Young said. “We don’t know how much benefit.”

Andrew Pruitt, a physician’s assistant at the Boulder Center for Sports Medicine, said that although many “notable orthopedic doctors recognize what it does on the cellular level,” how it works is unclear.

The answer may lie in what glucosamine really is. The most common sources for glucosamine is from bovine and shellfish byproduct.

“Glucosamine sulfate is an actual component of cartilage,” Green said. “(Taken as a supplement) it either increases the build of cartilage or retards the loss of it. Cartilage loss is the precipitating event for osteoarthritis.”

This is why Green only recommends it to patients with “true arthritis and cartilage loss,” he said, “not ones who have pain due to soft tissue injuries or other problems.”

Others concur. “We don’t recommend it for aches and pains,” Young said. “It’s used for osteoarthritis.”

Conditions such as tendonitis or carpal tunnel syndrome do not involve cartilage, and so glucosamine and chondroitin will not help with those conditions. “You should pin down the diagnosis as close as you can, or you could waste your money,” Green said.

Glucosamine and chondroitin are classified as supplements and therefore are unregulated by the Food and Drug Administration.

“There are about 40 different brands of over-the-counter glucosamine and chondroitin,” Pruitt said. He said that with some shoddy supplements, “There’s as much as 50 percent unknown substances. I advise you to ask the pharmacist what they would use to get pharmaceutical-grade glucosamine and chondroitin.”

The long-term effects of the supplements are unclear. “The longest conventional study has been three years,” Green said. “We don’t know if it will continue to be effective.”

Fortunately, there do not seem to be any negative side effects for most people, except for occasional gastro-intestinal upset, according to Green. “Diabetics should be cautious,” Green said “And because it’s a component of cartilage, you should check with your doctor if you have adverse reactions to shellfish or iodine or if you have clotting problems.”

Theodosakis disagreed that diabetics need to take precautions. “Just because ‘glucosamine’ sounds like ‘glucose’ does not mean it’s like taking sugar,” he said. “Besides, 1.5 grams of glucosamine, even if it was pure glucose, is about as much as one or two grapes or 0.5 ounces of soda or juice.

Most physicians tell their osteoarthritic patients to take about 500 milligrams of glucosamine and 400 milligrams of chondroitin three times per day. A one-month supply costs about $25 to $45, which is less than most prescription drugs used to treat osteoarthritis.

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