The following review of DONA„ or glucosamine sulfate supplements, was borrowed with permission from the new arthritis book by Carol Eustice, the guide on arthritis for About.com since 1997, and Scott Zashin M.D., a widely respected and recognized arthritis specialist, the former primary arthritis consultant for About.com, and current arthritis expert for Web MD.
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Borrowed from Chapter 5The Buzz about Glucosamine
The buzz about glucosamine was everywhere back in the 1990s, or so it seemed. As much as we€™re hearing about vitamin D today, that€™s what it was then€”about glucosamine. Some called it €œan arthritis cure€ and €œa medical miracle.€ Glucosamine had the potential to halt, reverse, and even possibly cure osteoarthritis, one doctor wrote in a book about the supplement.1 Those were hefty promises that capture people€™s attention€”and they did. But over the years, from clinical trials to patient testimonials, the news about glucosamine grew somewhat dimmer. The biggest of the trials was the NIH Glucosamine/Chondroitin Arthritis Intervention Trial, better known as the GAIT trial, but its data weren€™t published until 2006, years after the hype began. And rather than provide solid conclusions, GAIT even stirred some controversy, as you will see. Glucosamine ExplainedGlucosamine is a natural substance that is found in healthy cartilage (the tissue that covers the ends of the bones in joints). More specifically, glucosamine sulfate is a component of glycoaminoglycans, or GAGs, combinations of proteins and sugars that are found in various tissues of the body, including in the matrix of cartilage and in joint fluid. Studies have shown that taking glucosamine supplements results in pain relief equivalent to some NSAIDs (nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen). It has also been theorized that glucosamine may slow cartilage damage in osteoarthritis patients. Glucosamine supplements are derived from the shells of shellfish (e.g., shrimp, lobster, and crab). Glucosamine is available in capsules, tablets, liquid, or a powder that must be mixed with a drink. For any of those formulations, 1,500 mg per day is the recommended dose of glucosamine to treat osteoarthritis. Many resources suggest that glucosamine should be avoided in patients who are allergic to shellfish, while other resources (including the Arthritis Foundation) recommend talking to your doctor about your known allergy. Most allergies are caused by proteins in shellfish, not by chitin, the substance from which glucosamine is extracted. Again, this is important to discuss with your doctor! What is clearly emphasized is that if glucosamine has any chance of helping you, it€™s important to be compliant with the recommended dose. You can stay on your usual arthritis medications while taking glucosamine. If there will be a symptomatic benefit from taking glucosamine, you should notice it within 3 months. The Supplement IndustrySince the supplement industry is largely unregulated, you the consumer are left to wonder about the quality and purity of the supplements you purchase. One laboratory (http://www.consumerlab.com) analyzed certain dietary supplements for quality, and it was found that in some cases, the product did not contain the amount of the supplement that was indicated on the label. I don€™t think any of us believes that paying for an inferior product is acceptable. It is best to stick with large, well known companies when buying supplements. Reputation is essential when choosing a brand. We€™ll discuss what many feel is the best glucosamine product in a bit.Potential Benefits of GlucosaminePrimarily, there are three potential benefits of glucosamine. One is that it slows cartilage deterioration. Second, it potentially relieves pain associated with osteoarthritis. Third, glucosamine may improve joint mobility. Recommended Use of Glucosamine Knee OsteoarthritisBased on human clinical trials, there is evidence to support the use of glucosamine sulfate for the treatment of mild to moderate knee osteoarthritis. Most clinical studies have used glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium). It remains unknown whether glucosamine made by other manufacturers is equally effective.A common criticism of studies that have not found glucosamine to be beneficial is that such studies either included patients with severe osteoarthritis or used products other than glucosamine sulfate. There are other forms of glucosamine, such as glucosamine hydrochloride.General Osteoarthritis There have been human clinical studies and animal experiments that offered positive results for glucosamine in treating osteoarthritis of various joints of the body. The evidence is less substantial than what exists for knee osteoarthritis. Pain relief, an anti-inflammatory effect of glucosamine, and improved joint function were among the positive findings. But the studies were deemed not well designed, leaving the door open for more study. Low-Back PainIn July 2010, study results were published in the Journal of the American Medical Association (JAMA), focusing on glucosamine as a potential treatment for low-back pain. The clinical trial was conducted at Oslo University Hospital in Norway and involved 125 patients who took glucosamine sulfate and 125 who took a placebo for six months. Researchers found no significant differences and no reduction in pain-related disability between the glucosamine group and the placebo group, during the study and after one year. The patients involved in this study were older than 25 years old and had lower-back pain for at least six months and degenerative lumbar osteoarthritis.
Possible Side Effects/Adverse Reactions of Glucosamine
There are common side effects associated with glucosamine. Glucosamine may cause mild stomach upset, nausea, heartburn, diarrhea, and constipation and may possibly increase blood glucose, cholesterol, triglycerides, and blood pressure. There have also been reports of glucosamine causing drowsiness, insomnia, headache, skin reactions, sun sensitivity, and nail toughening.4 5 It is recommended that before stopping the supplement, you should switch brands to see whether the problem resolves. If mild symptoms develop from the product, Dr. Zashin would recommend that his patients discontinue it. Assuming that symptoms improve once off of the supplement, you may consider resuming at a lower dose or trying glucosamine sulfate, if not presently taking this form. You should discontinue glucosamine if side effects recur after changing the dose or the brand. 4 MedlinePlus, €œGlucosamine€ (August 2009). Ultimately, it is not clear whether glucosamine affects blood sugar levels. Some studies have suggested that glucosamine taken by mouth has no effect on blood sugar, while other studies have reported mixed effects on insulin. Caution is advised in patients with diabetes or hypoglycemia and in those taking drugs that are known to affect blood sugar. Caution is also advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary in such cases. In women who are pregnant or who are breast-feeding, glucosamine is not recommended due to a lack of scientific evidence pertaining to this population of patients.