- CHONDROTIN SULFATE
:
Chondroitin is a simple molecule
that occurs naturally in the body. It is a major component of cartilage
-- the tough, connective tissue that cushions the joints. Chondroitin
helps to keep cartilage resilient by absorbing fluid (particularly water)
into the connective tissue. It is also believed to block enzymes that
break down cartilage and it provides the building blocks needed for
cartilage to repair itself.
Based on clinical evidence, chondroitin
may be an effective treatment for osteoarthritis (OA). OA is a type
of arthritis caused by the inflammation, breakdown, and eventual loss
of cartilage. Chondroitin supplements have been shown to decrease the
pain of OA and slow the progression of the disease. Unlike current medical
treatments for arthritis, such as ibuprofen and other NSAIDs (nonsteroidal
anti-inflammatory drugs), chondroitin causes virtually no side effects.
Also, many NSAIDs and pain relievers treat the symptoms of OA but do
not slow the progression of the disease, and may cause serious side
effects such as stomach bleeding from ulcers or other causes. Chondroitin
is often taken with glucosamine, another supplement thought to be effective
in treating OA.
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Therapeutic Uses
Treatment
Osteoarthritis
Results from several well-designed scientific
trials indicate that chondroitin supplements may be an effective treatment
for OA -- particularly OA of the knee or hip. In general, findings from
these studies suggest that chondroitin:
Significantly reduces OA pain
Improves functional status of people with hip or knee OA
Reduces joint swelling and stiffness
Provides relief from OA symptoms for up to 3 months after treatment
is discontinued
Although some improvement may be experienced sooner, the full effectiveness
of chondroitin generally begins after 2 to 4 months of use. Chondroitin
may also be used along with NSAIDs in the treatment of OA.
Perhaps the most definitive results regarding
the effectiveness of chondroitin for OA will be achieved with the ongoing
Glucosamine/Chondroitin Arthritis Intervention Trial sponsored by the
National Institutes of Health. This large-scale study involving over
1600 people is investigating the effects of chondroitin alone, glucosamine
alone, or a combination of both for the treatment of knee OA. Results
are expected in 2005.
Other
Other conditions for which chondroitin
has been suggested include preterm labor, Alzheimer's disease, heart
disease, and osteoporosis. For all of these conditions, it is much too
early to tell if chondroitin is helpful or harmful. The role of chondroitin
in each of these conditions is under various stages of scientific investigation.
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Dietary Sources
The use of chondroitin as a therapy for OA (and other conditions) requires
dietary supplements because the precise amount of chondroitin in foods
is unknown. Meats with visible connective tissue may be sources of chondroitin,
but the exact quantity of chondroitin present in such foods is unknown.
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Dosage and Administration
Chondroitin is commonly sold as chondroitin sulfate in capsule or tablet
form. It is also available in combination with various forms of glucosamine
and sometimes manganese as well. (Manganese is a trace element necessary
for normal bone health. While the total amount of manganese from foods
and/or supplements should not exceed 11 mg/day, several combination
supplements for arthritis [containing glucosamine, chondroitin, and
manganese] contain more than that. Read labels carefullly.)
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Pediatric
Chondroitin is not currently recommended for children. Because it is
primarily used for treatment of osteoarthritis (a condition that affects
older people), it is generally not used in children and its safety for
children has not been studied.
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Adult
400 mg twice a day or 800 mg once a day taken orally.
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Precautions
Because of the potential for side effects and interactions with medications,
dietary supplements should be taken only under the supervision of a
knowledgeable healthcare provider.
As with all supplements, the purity and
concentration of chondroitin may vary from one product to another. Researchers
at an independent laboratory that tests the purity of health, wellness,
and nutrition products, discovered that more than half of the preparations
of chondroitin, and combination products of glucosamine and chondroitin
tested contained levels of chondroitin that were lower than what the
label stated. As mentioned above, this same laboratory also detected
levels of manganese in some chondroitin preparations that exceeded tolerable
limits.
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Side Effects
Chondroitin is safe and relatively free of side effects when used at
the recommended daily dosage at least for short periods of time. Unfortunately,
few studies have investigated the safety and effectiveness of chondroitin
when used for long periods of time. Until the long-term use of chondroitin
is deemed safe, it is best to consult a healthcare practitioner before
taking chondroitin supplements.
Mild side effects of chondroitin reported
in recent studies include diarrhea, constipation, and abdominal pain.
There have been rare reports of swelling and accumulation of fluid in
the eyelids and lower limbs, irregular heartbeats, and alopecia (hair
loss) after taking the supplement.
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Pregnancy and Breastfeeding
Since the safety of chondroitin has not been widely studied, pregnant
and breastfeeding women should refrain from using this supplement until
more scientific evidence becomes available.
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Interactions and Depletions
If you are currently being treated with any of the following medications,
you should not use chondroitin without first talking to your healthcare
provider.
Blood-thinning Medications
Chondroitin and heparin, a drug used to
thin the blood, are similar in chemical composition. For this reason,
some researchers speculate that people may suffer bleeding complications
from chondroitin, particularly when it is used in combination with other
blood-thinning medications, such as warfarin or heparin.
Cisplatin
Preliminary animal studies also suggest
that chondroitin sulfate may reduce the kidney toxicity associated with
cisplatin, a chemotherapy drug used for cancer treatment. Further studies
are needed to determine whether chondroitin has the same effect in people
taking cisplatin.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Taking chondroitin supplements may result
in a decreased need for NSAIDs such as ibuprofen to relieve the pain
and swelling associated with OA. Because NSAIDs and aspirin can cause
serious side effects, such as stomach bleeding and ulcers, chondroitin
may be a useful adjunct or even alternative. Be sure to consult your
healthcare provider before adding chondroitin to your healthcare regimen.
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Supporting Research
Bourgeois P, Chales G, Dehais J, Delcambre B, Kuntz JL, Rozenberg S.
Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin
sulfate 3 x 400 mg/day vs placebo. Osteoarthritis Cartilage. 1998;6(suppl
A):25-30.
Brown KE, Leong K, Huang C, et al. Gelatin/chondroitin
6-sulfate microspheres for the delivery of therapeutic proteins to the
joint. Arthritis and Rheum. 1998;41(12):2185-2195.
Busci L, Poor G. Efficacy and tolerability
of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis
(SYSADOA) in the treatment of knee osteoarthritis. Osteoarthritis Cartilage.
1998;6(suppl A):31-36.
Chavez ML. Glucosamine sulfate and chondroitin
sulfates. Hosp Pharm. 1997;32(9):1275-1285.
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