I am terrified of the possibility of a joint replacement when I am older.  It just seems so painful.  As a runner, biker and worker-outer in general, whenever I have a few days of hip pains or knee aches I start to worry about the future of my joints.  I’m not even 30 yet, what will my knees feel like when I am 55?!  I want to avoid things like steroid injections and surgery.  Is there a more natural way to protect my joints?  If they cause problems as I age, is there a less invasive cure for my achy knees?

I have heard a lot about glucosamine and chondroitin informally- from friends, family and patients.  Most praise them stating that their aches and pains have almost completely resolved with use of these supplements.  But what does research say?  Are glucosamine and chondroitin effective or are my cartilage lacking friends and family just experiencing a placebo effect?

What are Glucosamine and Chondroitin?

Glucosamine and chondroitin are substances naturally found in healthy cartilage.  Molecularly, glucosamine is a sugar while chondroitin is a complex carbohydrate that helps cartilage retain water.  Glucosamine found in manufactured supplements is harvested from the shells of shellfish (Note: do not recommend glucosamine to patients with shellfish allergies) while chondroitin is manufactured from animal products such as cow cartilage.

In the body, glucosamine is present in synovial fluid surrounding the joints.  The body uses it to help build tendons, ligaments, cartilage and joint fluid.  Chondroitin naturally found in the body ensures that cartilage is able to hold water allowing for proper joint lubrication. It contains anti-inflammatory properties, stimulates cartilage production and also production of hyaluronic acid an important component of joint fluid.

Are Glucosamine and Chondroitin Effective in Treating Joint Pain?

Clinical studies regarding the efficacy of glucosamine and chondroitin in treating joint pain show mixed results.  Some studies show small to moderate pain relief with these supplements while others show no effect.  Dr. Chu of the Cartilage Restoration Center notes that the studies indicating these supplements are effective typically have participants taking them in much higher concentrations than usual.  Nicholas Sotereanos, director of the Center for Restorative Joint Surgery notes that the most famous study indicating that glucosamine and chondroitin are effective was funded by a pharmaceutical company causing doubt about it’s validity.  A study published in the New England Journal of Medicine found that sufferers of mild arthritis pain did not experience relief with glucosamine and chondroitin but that patients with moderate to severe osteoarthritis did have relief of their symptoms when taking the supplements.

Overall, studies on the effects of glucosamine and chondroitin indicate that for sufferers of mild joint pain, these supplements will be ineffective in providing pain relief.  For individuals with moderate to severe pain, they may be of some benefit.  More research is needed to further explore this topic.

Are Glucosamine and Chondroitin Safe?

Despite the fact that research has labeled these supplements ineffective, millions of Americans take them.  Thankfully, glucosamine and chondroitin have a rather benign safety profile.

Glucosamine should absolutely not be taken by individuals with shellfish allergy as it is manufactured from shells.  Side effects reported by glucosamine users include nausea, heartburn, diarrhea and constipation.  Some research indicates that glucosamine may raise blood sugar in diabetic patients.  Glucosamine should also not be taken in combination with Warfarin (Coumadin) as is lowers it’s efficacy.  Glucosamine is usually taken as a 1500mg daily tablet or a 500mg tablet taken three times daily.

The most common side effects reported with chondroitin use include nausea and stomach discomfort.  Concern has also been raised that because chondroitin is manufactured from animal products, contamination of the supplement is possible.  No contamination incidents have been reported to date. Some research indicates that chondroitin may make asthma worse and therefore it should not be taken by individuals with asthma.  Men diagnosed with prostate cancer should also not take chondroitin as it may cause cancer spread or recurrence. Like glucosamine, individuals taking Warfarin (Coumadin) should not use chondroitin supplements as they decrease Warfarin’s efficacy.

Chondroitin is taken as a 1000 to 1200mg tablet taken once daily or 200 to 400 mg tablet taken two to three times daily.  It also comes in the form of a cream and can be applied to the skin over sore joints as needed for up to 8 weeks.

Should You Recommend Glucosamine and Chondroitin Supplements to Your Patients?

Unfortunately, given the research it does not seem like these supplements are very effective and will therefore likely not be of benefit to your patients.  They do, however have a rather benign safety profile.   It may be worth recommending them to sufferers of moderate to severe joint pain and arthritis for a trial period.  Remember to use caution in prescribing them to asthmatics.  Do not prescribe them to individuals with shellfish allergy.

Given the mixed research results along with the positive testimonials I have heard from others, I have decided to try glucosamine and chondroitin myself.  My knees are aching as I have recently changed my running routine.  I also have a mild case of plantar fascitis.  Let’s see if they will help my aches and pains.  I will update you in a few weeks as to my personal research results!

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