Glucosamine – Should you supplement?

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There is little evidence that glucosamine can accomplish some of its claimed benefits in patients, particularly in terms of restoring joint cartilage or slowing the progression of arthropathies.28 There is no histological study to support this claim. Only a few randomised double-blind trials of glucosamine treatment have assessed outcomes.

 The hexose sugar structure of glucosamine might exacerbate diabetes. In animal models of diabetes, glucosamine increased insulin resistance through an unknown mechanism.

 Glucosamine is subject to a high degree of first pass metabolism, such that oral bioavailability is poor.

The half-life has been reported to vary from 28 to 58 hours.  The small percentage that survives firstpass entry into the circulation is transported by an unknown carrier in the vessels to reach the synovial joint. Any glucosamine molecules that reach the joint need to enter the cartilage. However, there are few or no blood vessels in cartilage. Therefore glucosamine molecules need to either diffuse across synovial fluid or enter via the dense bone-cartilage interface in order to arrive at the hyaline cartilage. Once there, the monosaccharide or sulphated monosaccharide needs to be reassembled into a much larger proteoglycan and GAG macromolecules, but the enzyme that performs this task is unknown.

 It is recommended that glucosamine be taken for 6 to 8 weeks before any symptom relief can be expected, but there is no evidence to support this belief. We consider that it is likely to be no more effective than a placebo.

 According to the Cochrane review, there was significant difference between glucosamine and placebo with respect to effects on pain, function, and range of movement.27 Histological analysis of the alleged benefits of glucosamine is lacking.

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In short.

  • Glucosamine is not a proven science.
  • Taken orally it has low bioavailability.
  • The hyaline cartilage (the part where glusosamine supposedly helps – not all cartilage) have very little or no blood vessels hence its effects questionable. It needs to transverse via the synovial or the dense bone cartilage in order to reach the hyaline cartilage which is highly improbably
  • It has a short half-life 28-58 which means need constant usage
  • Studies suggest that it increases insulin resistance– hence you may  need to take the product in “cycles” so that you re-sensitise your insulin receptors.
  • Stabilizer for glucosamine is typically salt – especially in Sulphate form

REFERENCES

 

  1. Orthopaedic basic science: biology and biomechanics of the musculoskeletal system. In: Buckwalter JA, Einhorn TA, Simon SR, editors. 2nd ed. Rosemont [IL]: American Academy of Orthopedic Surgeons; 2000.
  2. Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulphate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002;162:2113–23.
  3. Reginster JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001;357:251–6.
  4. Bassleer C, Rovati L, Franchimont P. Stimulation of proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritic articular cartilage in vitro. Osteoarthritis Cartilage 1998;6:427–34.
  5. Das A Jr, Hammad TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage 2000;8:343–50.
  6. Choice.com.au. Australian Consumers’ Association. Available from: http://www.choice.com.au/viewArticle.aspx?id=106316&catId=100231&tid=100008. SG Kirkham and RK Samarasinghe
  7. Annual nutrition industry overview. Business J 2005;X:6–7. [not found]
  8. McColl G, Glucosamine for osteoarthritis of the knee. Australian Prescriber 2004;27:?. [not found]
  9. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000;43:1905–15.
  10. Theodosakis J, Fox B, Adderly B. The arthritis cure: the medical miracle that can halt, reverse, and may even cure osteoarthritis. New York: St Martin’s Press; 1997.
  11. Young B, Lowe JS, Stevens A, Heath JW. Wheater’s functional histology: a text and colour atlas. 4th Ed. Churchill Livingstone; 2000:172.
  12. Dieppe P. What is the relationship between pain and OA. Rheumatology in Europe 1998;27:55–6. [not found]
  13. Martin DW, Mayes PA, Rodwell VW. Harper’s review of biochemistry. 18th Ed. New York: Lange Medical Publications; 1981:146.
  14. Barclay TS, Tsourounis C, McCart GM. Glucosamine. Ann Pharmacother 1998;32:574–9.
  15. Setnikar I, Giachetti C, Zanolo G. Absorption, distribution and excretion of radioactivity after a single intravenous or oral administration of [14C] glucosamine to the rat. Pharmatherapeutica 1984;3:538–50.
  16. Reichelt A, Forster KK, Fischer M, Rovati LC, Setnikar I. Efficacy and safety of intramuscular glucosamine sulfate in osteoarthritis of the knee. A randomised, placebo-controlled, double-blind study. Arzneimittelforschung 1994;44:75–80.
  17. Chard J, Dieppe P. Glucosamine for osteoarthritis: magic, hype, or confusion? It’s probably safe-but there’s no good evidence that it works. BMJ 2001;322;1439–40.
  18. Setnikar I, Palumbo R, Canali S, Zanolo G. Pharmacokinetics of glucosamine in man. Arzneimittelforschung 1993;43:1109–
  19. Setnikar I, Giacchetti C, Zanolo G. Pharmacokinetics of glucosamine in the dog and in man. Arzneimittelforschung 1986;36:729–35.
  20. Bassleer C, Henrotin Y, Franchimont P. In-vitro evaluation of drugs proposed as chondroprotective agents. Int J Tissue React 1992;14:231–41.
  21. Setnikar I, Cereda R, Pacini MA, Revel L. Antireactive properties of glucosamine sulfate. Arzneimittelforschung 1991;41:157–
  22. Karzel K, Domenjoz R, Effect of hexosamine derivatives and uronic acid derivatives on glycosaminoglycan metabolism of fibroblast cultures. Pharmacology 1971;5:337–45.
  23. Hughes R, Carr A. A randomized, double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee. Rheumatology (Oxford) 2000;41:279–84.
  24. Scroggie DA, Albright A, Harris MD. The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Arch Intern Med 2003;163:1587–90.
  25. Pujalte JM, Llavore EP, Ylescupidez FR. Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthritis. Curr Med Res Opin 1980;7:110–4.
  26. Hooper M, Is glucosamine an effective treatment for osteoarthritic pain? Cleve Clin J Med 2001;68:494–5.
  27. Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Sys Rev 2005;2:CD002946.
  28. McAlindon T. Why are clinical trials of glucosamine no longer uniformly positive? Rheum Dis Clin North Am 2003;29:789–801

 

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