- GLUCOSAMINE SULFATE
:
Glucosamine, which occurs
naturally in the body, plays a key role in the construction of cartilage
-- the tough connective tissue that cushions the joints. Glucosamine
stimulates the production of glycosaminoglycans (the key structural
components of cartilage) as well as the incorporation of sulfur into
cartilage. Sulfur is necessary for making and repairing cartilage.
Glucosamine may be effective in treating
and possibly slowing the progression of osteoarthritis. This is a type
of arthritis caused by continuous wear and tear on the joints leading
to inflammation, breakdown, and eventual loss of cartilage. The tissues
most affected by osteoarthritis are the weight bearing joints, such
as the knees and hips, as well as the joints in the hands.
Studies suggest that glucosamine may be
at least as effective as some of the medications frequently used to
treat this joint condition, but with fewer gastrointestinal side effects.
The medications used to treat osteoarthritis are known as nonsteroidal
anti-inflammatory drugs (NSAIDs), such as ibuprofen and piroxicam. NSAIDs
may cause stomach upset, cramps, constipation, diarrhea, and in some
cases, stomach ulcers.
Glucosamine is often taken with chondroitin,
another supplement thought to be effective in treating arthritis. These
substances are often combined with manganese as well, a trace metal
that is also needed for building cartilage.
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Uses
Arthritis
Although not every single study agrees, strong evidence from many well-designed
trials, indicate that glucosamine sulfate supplements may be an effective
treatment for osteoarthritis -- particularly osteoarthritis of the knee.
In general, findings from these studies suggest that glucosamine provides
several benefits for people with osteoarthritis including pain reduction
(as effective as ibuprofen and other NSAIDs), improved function and
mobility, and slowed progression or even prevention of joint destruction
when taken for 3 or more years.
In comparison to NSAIDs, glucosamine takes
longer to begin working. However, pain control lasts longer with glucosamine
and the supplements cause fewer side effects.
Although glucosamine and chondroitin are
often administered together for the treatment of osteoarthritis, it
is not clear that the combination works better than either supplement
alone. Nor is it clear if glucosamine is better than chondroitin or
vice versa. Perhaps the most definitive results regarding the effectiveness
of glucosamine and chondroitin for osteoarthritis will be achieved with
the ongoing Glucosamine/Chondroitin Arthritis Intervention Trial sponsored
by the National Institutes of Health. This large-scale study involving
over 1,600 people is investigating the effects of glucosamine alone,
chondroitin alone, and a combination of both for the treatment of knee
osteoarthritis. Results are expected in 2005.
Inflammatory Bowel Disease (IBD)
Crohn's disease and ulcerative colitis are two inflammatory bowel diseases
that are marked by chronic, recurrent bloody diarrhea. Preliminary evidence
suggests that N-acetyl glucosamine oral supplements or enemas may improve
symptoms of IBD in children who do not improve from standard medical
treatments. Further research is needed, however, to determine whether
the substance is safe and effective for the treatment of IBD.
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Dietary Sources
There are no food sources of glucosamine. Supplements are derived from
either bovine cartilage or chitin, the hard outer shells of shrimp,
lobsters, and crabs.
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Available Forms
Glucosamine is available as an oral supplement in the following forms:
Glucosamine sulfate: 500, 750, and 1,000
mg capsules and tablets
N-acetyl glucosamine: 500 and 750 mg capsules and tablets
Glucosamine hydrochloride (HCL): 500, 750, and 1,000 mg capsules and
tablets
Glucosamine/chondroitin sulfate combination products (often contain
manganese as well)
Glucosamine sulfate is the form used in most research studies. It is
believed to be the best source because it provides the sulfur necessary
for making and repairing cartilage.
Glucosamine is also available as an injectable
form that your physician can insert directly into the arthritic joint.
N-acetyl glucosamine is also available as an enema.
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How to Take It
Pediatric
There are no known scientific reports on
the pediatric use of glucosamine. Therefore, it is not currently recommended
for children.
Adult
1,500 mg per day (500 mg three times a
day) for one to two months
Ongoing supplementation (roughly 1,000 mg per day) may be required to
prevent the progression of osteoarthritis or to reduce pain and inflammation
associated with the condition.
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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.
The majority of studies indicate that glucosamine
is safe, nontoxic, and causes only minor side effects such as stomach
upset, heartburn, indigestion, gas, bloating, and diarrhea. If these
symptoms occur, glucosamine should be taken with food.
People with peptic ulcers should take glucosamine
sulfate with food.
Glucosamine sulfate may contain high amounts
of sodium or potassium, so individuals on a restricted diet or taking
potassium-sparing diuretics should carefully check the label before
taking glucosamine supplements.
People with diabetes should have their
blood sugar checked regularly as glucosamine may cause insulin to work
less effectively. Some glucosamine supplements are derived from shellfish,
so individuals with shellfish allergies should check with a health care
professional before taking these supplements.
People who are allergic to sulfur are usually
allergic to sulfa drugs or sulfite-containing food additives. Sulfur
is an essential nutrient that is naturally present in the body of all
individuals. "Sulfur-sensitive" people can safely use glucosamine
sulfate.
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Possible Interactions
If you are currently being treated with any of the following medications,
you should not use glucosamine or make any adjustments to your medications
without first talking to your healthcare provider.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Glucosamine may increase the anti-inflammatory activity of NSAIDs such
as ibuprofen. This interaction may result in the need for lower doses
of these medications.
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Supporting Research
Adams ME. Hype about glucosamine [editorial]. Lancet. 1999;354:353-354.
Chard J. Glucosamine for osteoarthritis:
magic, hype, or confusion? It's probably safe-but there's no good evidence
that it works [editorial]. BMJ. 2001;322:1439-1440.
da Camara CC, Dowless GV. Glucosamine sulfate
for osteoarthritis. Ann Pharmacother. 1998;32:580-587.
Das A, Hammond 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(5):343-350.
Deal CL, Moskowitz RW. Nutraceuticals as
therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin
sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999;25:379-395.
Delafuente JC. Glucosamine in the treatment
of osteoarthritis. Rheum Dis Clin North Am. 2000;26(1):1-11.
Gaby AR. Natural treatments for osteoarthritis.
Altern Med Rev. 1999;4(5):330-341.
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