The information contained on this page should not replace the recommendations and indications provided by your doctor. Glucosamine and chondroitin are nutritional supplements and as such are not subject to the same strict regulations required for over-the-counter and nonprescription drugs. Therefore, if you decide to take any supplement, you will do so on your own. Check with your doctor before trying these supplements. Make sure that the cause of the pain is osteoarthritis . Do not interrupt or reduce the dose of prescription medications you are currently taking until you see the doctor.
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What are glucosamine and chondroitin sulfate?
This supplement may contain glucosamine in the form of N-acetyl glucosamine or sulfate salts or hydrochloride, and chondroitin as chondroitin sulfate. Both are substances that occur naturally in the body, present in the cartilage and that help to maintain their elasticity, lubricating the joints.
Glucosamine:
- Glucosamine is an aminosaccharide that plays an important role in the formation and repair of cartilage.
- Glucosamine, as a supplement, is extracted from crustaceans (such as lobsters, shrimp or crabs).
Chondroitin sulfate:
- Chondroitin sulfate is part of a large protein molecule (proteoglycan) that provides elasticity to cartilage.
- Chondroitin sulfate is extracted, in most cases, from the cartilage of the cattle trachea, but in Japan it is also extracted from shark cartilage. Like glucosamine, it can be synthesized in the laboratory.
What are these supplements used for?
- These supplements have been used to treat osteoarthritis (OA) in horses and dogs for many years.
- In Europe, glucosamine and chondroitin sulfate have been used to treat OA in humans since 1980.
- It is important to remember that these supplements have not been well studied as treatment for other forms of arthritis or associated diseases, such as rheumatoid arthritis (RA) or gout , or to treat other causes of pain, such as stress fractures.
What studies have been done?
- A small study conducted in 2012 showed improvement in symptoms when using glucosamine together with an NSAID, and a minor, but significant relief with glucosamine alone.
- In 2015, a couple of studies were conducted on the use of glucosamine and chondroitin for the management of knee pain associated with OA. In the first, the effectiveness and safety of the supplement was compared with that of celecoxib (medicine marketed as Celebrex ). It was found that the supplement in question showed comparable efficacy to the drug in reducing pain, stiffness, functional limitations and joint inflammation after prolonged use for six months. (ARD Online First, Jan 14, 2015. Ann Rheum Dis doi: 10.1136 / annrheumdis-2014-206792 )
- The most recent study, published in March 2015, which also analyzed the effectiveness of the supplement in patients with knee OA , gave less encouraging results. According to the researchers, the supplement was not shown to significantly relieve symptoms or modify the progression of OA. ( Effects of Glucosamine and Chondroitin Supplementation on Knee Osteoarthritis, Arthritis and Rheumatology, March 2015 ).
What do these supplements do?
- In studies conducted mainly in Europe, some people with mild to moderate OA who took glucosamine or chondroitin sulfate showed some relief of pain and a better functioning of the joint. However, the research findings in the US are not consistent, since contradictory results have been observed.
What characteristics should the supplement have?
- Glucosamine comes in various forms, the most common being glucosamine sulfate and glucosamine hydrochloride. Although both have the same efficacy, most studies used the sulfate salt.
- Shark cartilage products contain chondroitin sulfate, but the quantity and quality of it is not consistent.
- Since dietary supplements are not strictly regulated, the quality and content can vary widely.
Some suggestions for choosing quality products are:
- Select a product manufactured by a large and respectable company that can take responsibility.
- Read the labels of the products carefully to make sure that the list of ingredients makes sense.
- Ask for recommendations to your doctor or pharmacist.
- If you are allergic to shellfish or have an excellent diet of animal products, look for vegetarian / vegan formulas.
How are these supplements taken?
- If you decide to try these supplements, experts recommend taking the amount used in most clinical studies:
- Glucosamine: capsules, tablets, liquid or powder, 1,500 mg (milligrams) per day.
- Chondroitin: capsules, tablets and powder, 800 to 1,200 mg per day divided into two to four doses.
- If this dose relieves the symptoms, you can decrease the amount gradually after the first few months.
- It may take a month before you notice any improvement.
- It is generally recommended to ingest glucosamine and chondroitin sulfate together, although it is not known for sure if the combination has a better effect than the individual use of each substance.
- You should plan your intake of the supplements along with the medications you currently take for 6 to 8 weeks. If the pain goes down, ask your doctor if you should decrease or stop the other medications for a period of time, to check if any changes in pain and stiffness levels are made.
- If after four to six months you do not notice any change in symptoms, the supplements probably will not provide any relief. Some people may experience partial relief using the supplements, but they may need to continue taking medications for complete relief.
Do these supplements have side effects?
Both glucosamine and chondroitin sulfate can have the following adverse effects:
- Increase in intestinal gas
- Stomach ache
- Softer stools
Precautions
Children, pregnant women and women who may become pregnant should not take these supplements. These substances were not studied enough to determine the effects they could have on a developing fetus or a child.
People who have the conditions listed below should be cautious with these supplements:
Glucosamine:
- Diabetes, since glucosamine is an aminosugar, dietetics must control blood sugar levels more frequently when taking these supplements.
- Individuals on anticoagulants such as warfarin ( Coumadin ) in combination with glucosamine hydrochloride with or without chondroitin should refrain from taking the supplement.
- Allergy to seafood, if you are allergic, consult your doctor before you start taking glucosamine. In most cases, allergies are caused by the proteins found in seafood, not by chitin, the carbohydrate from which glucosamine is extracted.
- Glaucoma, a new study suggests that people with this disorder or with intraocular hypertension may worsen eye pressure if they take glucosamine. Other side effects are increased triglycerides and cholesterol.
Chondroitin sulfate:
- This supplement may include components with structure similar to heparin, an anticoagulant drug, so ingesting it together with an NSAID, such as aspirin, could increase the risk of bleeding. In this case it is advisable to take the prothrombin time and coagulation more frequently.
- Certain tablets may contain high levels of manganese (Mn), which could cause long-term nervous system poisoning (if it exceeds 11 mg Mn / day). In addition, since chondroitin comes from cattle, there is the remote possibility of contamination associated with mad cow disease.
- If you are allergic to sulfonamides, avoid it, or start with small doses of chondroitin and be alert for side effects. Other effects are diarrhea or constipation.
Considerations:
- The American College of Rheumatology, in its most recent recommendations for the initial treatment of OA (2012) does not recommend glucosamine or chondroitin to patients with osteoarthritis. Glucosamine and chondroitin alone or together do not always work for everyone. However, those who decide to try these supplements and benefit from them do not have to suspend them. Taking them for the long term seems to be safe.
- Note that studies of the supplement have been done in patients with knee pain associated with OA, so it can not assume the validity of its use in other joints of the body or for other types of arthritis.
- Discrepancies in the effectiveness of chondroitin can also be generated from variations in the doses and quality of the supplements. The content of chondroitin tends to vary quite a lot between different brands. The same can be said about glucosamine supplements. Talk to your doctor or pharmacist about which brand to choose from any of these products, or combination thereof.