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Glucosamine and Chondroitin

What are glucosamine and chondroitin?

Glucosamine and chondroitin are part of normal cartilage. Cartilage acts as a cushion between the bones in a joint.

Glucosamine, also called chitosamine, is a natural substance that is found in the covering of shellfish. It is available in different forms, including glucosamine hydrochloride, N-acetyl-glucosamine (NAG), and glucosamine sulfate, which is a combination of glucosamine and mineral salt. Glucosamine is also available in synthetic forms. The body absorbs glucosamine well.

Chondroitin can come from natural sources, such as shark or bovine cartilage, or it can be made in a lab. Chondroitin is also known as chondroitin sulfate, chondroitin sulfuric acid, and chonsurid. Chondroitin sulfate is a combination of chondroitin and mineral salt.

Glucosamine and chondroitin are available in tablet, capsule, powder, or liquid form and are often taken in combination with each other or in combination with other dietary supplements. Glucosamine may be taken separately as a dietary supplement for joints.

What are glucosamine and chondroitin used for?

People with osteoarthritis use glucosamine and chondroitin to relieve joint pain.

Glucosamine and chondroitin, taken alone or together, have not always been shown to relieve pain of osteoarthritis in all people.1 But glucosamine and chondroitin taken together may help reduce pain in some people with moderate-to-severe knee pain.1 Some studies show that chondroitin alone may relieve pain and improve function.2

There are also some studies that indicate glucosamine may help as much as ibuprofen in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects.3

Research indicates that glucosamine and chondroitin can help restore cartilage.

Are glucosamine and chondroitin safe?

It appears that glucosamine and chondroitin, in combination or separately, have few side effects. But people with osteoarthritis who have diabetes should talk with a doctor before they take glucosamine, because it is thought that glucosamine may influence blood sugar (glucose).4

If you are allergic to shellfish, do not take glucosamine unless you have discussed it with your doctor. Glucosamine is made from shellfish covering.

The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements in the same way it regulates medication. A dietary supplement can be sold with limited or no research on how well it works.

Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breast-feeding.

When using dietary supplements, keep in mind the following:

* Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions, or interact with prescription and nonprescription medications or other supplements you might be taking. A side effect or interaction with another medication or supplement may make other health conditions worse.
* The way dietary supplements are manufactured may not be standardized. Because of this, how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form of supplement that you buy in health food or grocery stores may not be the same as the form used in research.
* Other than for vitamins and minerals, the long-term effects of most dietary supplements are not known.


Anyone Can Develop Osteoarthritis

Osteoarthritis, one of more than 100 types of arthritis and related diseases, is the most prevalent type of arthritis. In the United States, about 21 million people live with the disease. Osteoarthritis is most common among adults over 65 years old but people of any age can develop the disease. Prevalence rises significantly after age 50 in men and after age 40 in women. According to the American College of Rheumatology, 70 percent of people over the age of 70 have x-ray evidence of osteoarthritis.
Wear-and-Tear Arthritis

Osteoarthritis is caused by the breakdown of cartilage in one or more joints. Cartilage is composed of 65 to 80 percent water, collagen (fibrous proteins), proteoglycans (proteins and sugars which interweave with collagen), and chondrocytes (cells that produce cartilage). Cartilage is a hard but slippery tissue which serves as a cushion between the bones of joints, allowing the bones to glide over one another. Cartilage also absorbs shock from physical movements.

When cartilage loss occurs, the joint can deteriorate to the point of rubbing bone against bone. Changes in structures around the joint (muscles and tendons), fluid accumulation, and bony overgrowth (e.g., osteophytes or bone spurs) can develop, causing severe chronic pain, loss of mobility, and disability.

Osteoarthritis is also known as degenerative joint disease, DJD, wear-and-tear arthritis, and osteoarthrosis. The disease can affect joints in the:

* fingers
* hips
* knees
* feet
* spine

Based on x-ray evidence, the distal and proximal interphalangeal joints of the hand are most commonly affected by osteoarthritis, though they do not usually exhibit typical symptoms associated with the disease.
he hips and knees are the next most common sites of osteoarthritis and are almost always symptomatic. The first metatarsal phalangeal and carpometacarpal joints also are common sites of osteoarthritis observed on x-ray but the shoulder, elbow, wrist, and metacarpophalangeal joints are rare sites of osteoarthritis unless related to injury or trauma.
Osteoarthritis Risk Factors

Along with advancing age, other risk factors for osteoarthritis include:

* Female gender
* Injury to joints
* Repetitive use of joints
* Overweight or obesity
* Family history

By 2030, approximately 20 percent of Americans will be over 65 years old and at high risk for developing osteoarthritis.

How do glucosamine and chondroitin work?
Glucosamine and chondroitin are two molecules that make up the type of cartilage found within joints. Inside your joints, cartilage undergoes a constant process of breakdown and repair. However, to be properly repaired, the building blocks of cartilage must be present and available. The theory behind using the glucosamine and chondroitin joint supplements is that more of the cartilage building blocks will be available for cartilage repair.

* Glucosamine is a precursor to a molecule called a glycosaminoglycan-this molecule is used in the formation and repair of cartilage.

* Chondroitin is the most abundant glycosaminoglycan in cartilage and is responsible for the resiliency of cartilage.

Treatment with these joint supplements is based on the theory that oral consumption of glucosamine and chondroitin may increase the rate of formation of new cartilage by providing more of the necessary building blocks.

Do glucosamine and chondroitin supplements increase cartilage formation?
While it is an interesting theory, oral consumption of glucosamine and chondroitin has not been shown to alter the availability of these cartilage building blocks inside an arthritic joint. It has not been shown that consumption of joint supplements increases the quantity of these cartilage building blocks within any joint.

What research has investigated glucosamine and chondroitin?
There have been numerous studies to examine the treatment effects of glucosamine and chondroitin over short periods of time. Most of these studies last only one to two months; however, they have indicated that patients experienced more pain reduction when taking glucosamine and chondroitin than patients receiving a placebo. The improvement experienced by these patients was similar to improvements experienced by patients taking nonsteroidal anti-inflammatory medications (NSAIDs) that have been a mainstay of non-operative arthritis treatment. The difference is that NSAIDs carry an increased risk of side effects including gastrointestinal complaints and bleeding.

The joint supplements glucosamine and chondroitin have few side effects, and thus their use would be preferred if the effects of pain reduction were indeed the same. Furthermore, there is an indication that NSAIDs may increase the progression of arthritis, whereas glucosamine and chondroitin may offer a more protective effect to the cartilage surface.

There have been some recent investigations that are focusing on the two primary problems of earlier studies into the supplements glucosamine and chondroitin:

* Studying more patients
* Following these patients for a longer period of time

Because osteoarthritis is a chronic disease that progresses slowly over time, in order to test any treatment, a long period of follow-up is necessary. In one recent study, the effects of chondroitin in 372 patients over a minimum three month period was investigated. This study, which combined the data from other smaller studies, found that patients did have an improvement in their symptoms of pain.

There have also been long-term studies lasting over one year into the effects of glucosamine. These studies also have shown encouraging results. A presentation at the 1999 meeting of the American College of Rheumatology illustrated the findings of a three year long European study that compared the effects of glucosamine versus placebo in about 200 patients. The group of patients taking glucosamine had less pain and better x-ray findings than the group of patients taking the placebo.

What is known, also, is that there are effective treatments for osteoarthritis that every patient should be using before considering these supplements. Specifically, recommendations for weight control, exercise, proper use of medications, and joint protection are known to minimize the progression and improve symptoms of osteoarthritis. These steps must be taken by all arthritis patients for optimal treatment to take place.

How do Glucosamine and Chondroitin Work

By: Richard Stenlake, Compounding Chemist
Article used with permission.

Richard Stenlake is a registered pharmacist who owns the largest compounding pharmacy in Australia. Over many years he has pioneered the introduction of innovative medication ideas to the Australian market.

Arthritis is a degenerative joint disease that causes pain, inflammation and limited joint movement.

In osteoarthritis the joint that is affected has degenerated cartilage. As this is the cushion between the joints, one gets bone rubbing against bone and thus pain, inflammation and lack of mobility follows. Up until now the only relief from this pain was by way of treatment with nonsteroidal anti-inflammatory drugs (e.g. brufen, orudis) or by injection with steroids (e.g. cortisone). However, these only mask the symptoms and relieve the pain, and the disease continues to get worse. Thus, the spiral continues increasing the dose as the pain worsens. However here we create another problem as these drugs have deleterious side effects and may in fact cause certain features of osteoarthritis to progress faster.

Thus over the years the only relieve that may be obtained is by joint replaced by your surgeon. Even with artificial joints, the problem is not solved as these too have a finite life and will have to be replaced further down the track.

A NEW APPROACH

In the last few years, excellent results have however best achieved with a combination of natural nutritional supplements. In many cases these have been able to slow and eventually eliminate disease. This approach includes a combination of glucosamine and chrondroiton sulphate. These are substances we already consume and are produced in small amounts in our bodies and as such have no known side effects. There has been extensive study done on them, which has proved that both glucosamine and chondroitan work in both animals and humans.

WHAT IS GLUCOSAMINE AND HOW DOES IT WORK?

Firstly healthy cartilage needs three things: water for lubrication and nourishment, proteoglycans to attract and hold the water, and collagen to keep the proteoglycans in place.

Proteoglycans are like a rope that threads itself through the collage and are essential as they hold many times their own weight of water, which both lubricates and nourishes the collagen. If the cartilage is damaged the thread of rope becomes weak and ‘leaks’ out and thus the collagen loses its nourishment as the proteoglycans lose their grip and float away. Thus the cartilage cannot withstand shocks, cracks and may wear out completely.

Glucosamine is a major building block of the water – loving proteoglycans. Besides being a building block for the synthesis of proteoglycans, its mere presence acts as a stimulus to the cells that produce proteoglycans – in fact glucosamine is a key factor in determining how many proteoglycans are produced by the cells.

Glucosamine has been shown to speed up production of both proteoglycans and collagen and it normalises cartilage metabolism which helps keep cartilage from breaking down.

Thus because of the affect of glucosamine on cartilage metabolism it can in fact help the body to repair damaged or eroded cartilage. In other words, glucosamine strengthens your body’s natural repair mechanisms.
Besides stimulating cartilage production, glucosamine also reduces joint pain and inflammation.

CHRONDROITON SULPHATE

Where glucosamine helps form the proteoglycans that sit within the space in the cartilage, chrondroiton sulphate acts like ‘liquid magnets’. Chrondroiton is a long chain of repeating nigans that attracts fluid into the proteoglycan molecules.

This is important for two reasons:

the fluid acts as a spongy shock absorber
the fluid sweeps the nutrients into the cartilage. Joint cartilage has no blood supply thus all of its nourishment and lubrication comes from the fluid that ebbs and flows as pressure is applied and released to the joint. Without this fluid, cartilage would become malnourished, drier, thinner and more fragile.

HOW CHRONDROITON SULPHATE WORKS

Chrondoiton Sulphate is a long chain molecule with a negative charge attached to it. As these chains wrap around proteoglycans they repel each other and thus create spaces between each proteoglycan. These are what are known as matrixes within the cartilage and this is where the fluid flows. There may be as many as 10,000 of these chains on a single proteoglycan molecule – thus we have a super water retainer as these chains make sure all these molecules are away from each other and cannot clump together.

Besides drawing in precious fluid, chrondroiton :
protects cartilage and stops it from breaking down and inhibits certain ‘cartilage chewing’ enzymes interferes with the metabolism of other enzymes that will starve the cartilage of fluid stimulates production of proteoglycans, glucosamine and collagen.

 
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