Glucosamine Revisited

In the mid 1990s, patients were coming into my office and telling me that their horse or dog did not limp anymore after their veterinarian started them on glucosamine.

The patients reported that they felt better after taking it as well—though they hated the big, horse-size pills. Inspired by their remarks, I researched the science behind glucosamine and its relative, chondroitin sulfate. I concluded the data was convincing enough, the supplement could be helpful,and it certainly had no health risk. I then created a glucosamine-rich beverage called “Joint Juice” to solve the problem.

The science behind glucosamine was thin at the time. In the laboratory, glucosamine had been shown to stimulate joint tissue cells to perform several positive actions. First, the glucosamine was a precursor: a building block of the natural lubricant of the joint called hyaluronic acid. The more lubrication, the better the joint worked and felt. Second, glucosamine was a natural anti-inflammatory. Even low levels of anti-inflammatory agents appeared to have positive effects on multiple diseases, not just joint arthritis. Third, glucosamine was a building block for the matrix of articular cartilage. Articular cartilage, which covers of all the bones in a joint, is the surface that becomes damaged from sports or from the disease osteoarthritis. Lastly, glucosamine suppressed some of the degradative enzymes produced in the joint after injury: those enzymes that break down cartilage.

Glucosamine appeared to be the ultimate supplement: one that both relieved symptoms and improved the actual underlying disease. And it did no harm. Early fears that people with shellfish allergies could not take the supplement were solved by sourcing it from vegetables.

However, as with many natural food supplements, the pharmaceutical industry saw glucosamine as a threat.

A major NIH-funded double-blind study, which compared glucosamine and chondroitin sulfate to the leading arthritis drug Celebrex, demonstrated fewer efficacies when all patients were included. In patients with moderate-to-severe arthritis, the supplements showed similar efficacy to the more expensive drug.[1]

Since the lead investigator was an industry consultant, the press release claimed that glucosamine didn’t work. Yet those of us who treat patients didn’t care if glucosamine wasn’t as effective in people with very mild symptoms. We did care that it was as good as Celebrex for the people with moderate-to-severe pain. Over the years, more studies demonstrated glucosamine’s efficacy. Two recent major studies are worth noting. In one, the cartilage of the joints in 1,593 patients thickened after glucosamine and chondroitin treatment, indicating a reversal of the wear and tear of arthritis [2]. In the other study of 96,000 patients, the relative risk of colon cancer was reduced by 23% in the patients who regularly took glucosamine and chondroitin together[3].

We know that diets, supplements, and natural products that reduce inflammation appear to have multiple beneficial effects on our health. In the raging arguments over healthcare insurance, let’s not forget that we have control over much of our own health at our fingertips. And that horses and dogs don’t lie.

REFERENCES

1. ​Clegg DO, Reda DJ, Harris CL, Klein MA, O’Dell JR, Hooper MM, Bradley JD, Bingham CO, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR, Oddis C V., Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ (2006) Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. N Engl J Med 354:795–808

2. ​Raynauld J-P, Pelletier J-P, Abram F, Delorme P, Martel-Pelletier J (2016) Long-term effects of glucosamine/chondroitin sulfate on the progression of structural changes in knee osteoarthritis: 6-year follow-up data from the osteoarthritis initiative. Arthritis Care Res (Hoboken) 68:1560–1566

3. ​Kantor ED, Zhang X, Wu K, Signorello LB, Chan AT, Fuchs CS, Giovannucci EL (2016) Use of glucosamine and chondroitin supplements in relation to risk of colorectal cancer: Results from the Nurses’ Health Study and Health Professionals follow-up study. Int J Cancer 139:1949–1957