Glucosamine v’s Glucosamine

Well here's a mystery. A major study called: Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) was conducted in the USA. A paper published - available on pubmed gave the results, which suggest at best very inconclusive results.  It states: "Over 2 years, no treatment achieved a clinically important difference in WOMAC pain or function as compared with placebo." Basically it's saying Glucosamine is of very little if any benefit. This was a very large study and is portrayed by the medical profession as being definitive.

The problem is there are many other studies that say differently, and it is all two easy to search google for testimonials on the benefits of glucosamine. Medical science often ignores the testimonials, and makes no attempt to explain the discrepancy.

Then I found another paper on pubmed: Role of glucosamine in the treatment for osteoarthritis by Reginster, Neuprez, Lecart, Sarlet, and Bruyere. It makes the following points about GAIT:

  • In North America, glucosamine hydrochloride or sulfate and chondroitin sulfate are considered nutraceuticals, whereas in most European countries, these are marketed as pharmaceuticals. Therefore, production and marketing of glucosamine are more closely monitored in Europe. In North America, varying quantities of glucosamine have been noted in a survey of several nutraceuticals.

  • Most of the negative clinical trials were performed with glucosamine hydrochloride 500 mg three times daily, whereas most of the positive trials were performed with the GS powder for oral solution at the dose of 1,500 mg once daily. This obviously raises the question, so far unanswered, of the importance of sulfate and of its contribution to the overall effects of glucosamine. Although the sulfate is readily hydrolyzed from the glucosamine in the gastrointestinal tract, there are suggestions that sulfate is in itself clinically relevant.

  • Interestingly, the most clinically relevant results in GAIT were seen when sodium chondroitin sulfate was taken with glucosamine hydrochloride; whether this may be explained by an increase in the bioavailability of sulfates together with glucosamine requires further study. It is of note that several of the glucosamine preparations contain other salts that could potentially influence uptake and utilization of glucosamine.

  • The placebo response for many clinical trials with oral agents in treatment for knee OA has traditionally been around 30 % and these usual figures were replicated in the GUIDE study. The high placebo response in the GAIT (60.1 %) is of unknown significance.

This points out that the GAIT study used Glucosamine Hydochloride, where as, many other studies use Glucosamine Sulphate and there is a significant difference in outcomes. What is interesting to me is that reports generally on the GAIT study do not mention there are different "types" of Glucosamine or that it may matter. Although theoretically there might not be any expected difference, practice seems to indicate there is.

There also appears to be some problem with the GAIT study in that there is no adequate explanation for the improvement in patients taking placebo with twice the improvement for those taking placebo in other studies. If the the placebo response was as per other studies, almost all supplements trialed in GAIT would have had a significant impact over placebo. This fact alone calls into question the study and its efficacy. Papers reporting on GAIT make little or no comment.

Probably the most significant obstacle to the validity of studies like GAIT are personal testimonials. What is even more significant is that there is no attempt on the part of the medical profession that run studies like GAIT to explain the huge discrepancy between their trials and personal experience.  The medical profession often ignore, or ridicule such testimonials.

Some responses to a comments on a another study are given below. You can find these here at https://www.health.harvard.edu/blog/the-latest-on-glucosaminechondroitin-supplements-2016101710391.  You can see how those who find benefit find the studies questionable.

* Posted October 22nd, 2016 at 2:39 pm

Ally

For years I have taken glucosamine/chondroitin/MSM. When I take the pills after eating some food, I have NO problems. Occasionally, however, I forget the food – and then I have stomach burn!

* Posted October 23rd, 2016 at 10:48 pm

Rita

Hi Aly

I have been taking supplements for the last 9 years for joints and energy. I was told and directed to take ith food or after.

for a long while I did but when i forget it felt like I was going to throw up.

However now when i forget I don’t feel as bad. Supplements are like food and meant to be taken’t with food so it can interact better and you won’t feel the effect with a half full stomach.

Hope this helps

* Posted October 21st, 2016 at 3:49 pm

Janis Kvintus

I have taken this for years and it has helped me so much! The problem is it raises my blood pressure, even with my blood pressure medicine, so I had to stop taking it. My arthritis pain was so bad I started it again, and up went my blood pressure. So I stopped again and I take MSM for pain and optimized quercetin and bromelain , taurine and a few other supplements that help arthritis and I think I have found the answer. My blood pressure went down and no pain!

* Posted October 21st, 2016 at 3:10 pm

Stephanie

well, Doctor, All I know is that both my knees were in awful shape. Take in 25 years ago, Hit by a car on my bike, After flying straight up pasta 40 ft sign & all I knew to do was to place myself in a fetal position, I landed on my knees about one-quarter inch above my kneecaps. Then about 15 years ago I was walking my 3 65 to 90 pound Airedales when I fell in a hole about 8 inches deep at the edge of someone’s yard & my left knee went BACKWARDS three inches. Then last year I was walking fast on the deck & it was slick,( didn’t know!!!), & I went down with my right knee & ankle twisted behind me. I cannot afford to go to a doc. So I started taking Glucosamine/Chondroitin/w/MSM & my knees are almost healed!! The proof is in the pudding as the old saying goes. My sis has problems with iodine so she cannot take it. I am still trying to find a safe one for her. Thank you !!

* Posted October 20th, 2016 at 2:42 pm

Paul Kleiber

I replied to two of the comments made on this G&C article as I believe they hit the nail on the head. The key is in the efficacy of the brand. The ingredients used, I believe, will affect the way it is absorbed. Who knows what “brand(s)” were used in this and other studies? One comment asked if G&C was measured in the blood stream. Wouldn’t this make sense, rather than anecdotal evidence from people with varying reference points?

I have used G&C for over 20 years and researched it carefully, actually talking to a doctor at John Hopkins University doing initial studies. They were using Cosamin DS (NutraMax Labs) as their baseline. This brand has definitely worked for me – both in pain management and slowing the deterioration of cartilage. (I started after my first hip replacement having been told my other hip would be following soon. After 15 years I finally had my other hip replaced.) No study will change my mind. G&C is a naturally occurring substance, with the body producing less as it ages.

* Posted October 19th, 2016 at 5:56 pm

Cynthia Steinberger

Perhaps not relevant to humans, but I have one canine “double-blind” observation – A couple of years ago my 16 year old bichon was walking very slowly and stiffly, and was using his legs in an unusual way, a gait described by the (French speaking) veterinarian as an “amble”, perhaps indicating back pain – both legs on the same side moved forward together, instead of in opposition -usually one leg moves back while the one leg moves forward – the vet said, without great enthusiasm, that glucosamine might be worth a try; she agreed that clinical evidence was lacking. So I tried – and after a few weeks, I met a neighbour in the park, and as we walked back home with the dog, the neighbour commented that Mopsy was walking briskly again, like a young dog – “What happened to him? Have you discovered the fountain of youth?” she asked. I explained about the doggy glucosamine pills (and the neighbour was so very impressed with the change in Mopsy that she began taking glucosamine herself for joint stiffness).

The dog did not know whether he was being given an active substance or a placebo – and my neighbour was also ignorant of the dog’s treatment when she commented on the improvement. So one double-blind observation, in favour of glucosamine improving agility in an old bichon. (And my neighbour reports that her knees feel much better, but she does know what she is swallowing ….)

* Posted October 19th, 2016 at 12:07 pm

Vince

Perhaps a little balance here a common standard treatment also does not work “A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee” NEJM N Engl J Med 2002; 347:81-88 “..When medical therapy fails to relieve the pain of osteoarthritis of the knee, arthroscopic lavage or débridement is often recommended. More than 650,000 such procedures are performed each year at a cost of roughly $5,000 each. In uncontrolled studies of knee arthroscopy for osteoarthritis, about half the patients report relief from pain…. Results………At no point did either arthroscopic-intervention group have greater pain relief than the placebo group …………Furthermore, at no time point did either arthroscopic-intervention group have significantly greater improvement in function than the placebo group ‘” So why not complain about that.

* Posted October 18th, 2016 at 7:56 pm

Billy Holcombe

I have taken these supplements for 20+ years. I have thru the years ran out of them or was off my routine of taking them and I have noticed more pain not only in my joints, but also start having more pain in my leg from my sciatic nerve.

I first started eating gummy candies at a recommendation of my brother I had complained about my ankles bothering me in the morning when I got up. I am not sure how long I had been eating them when one morning I did not have the problem. When I ran out, it came back. I would start again and it would go away. I can affirm there is relief for me by taking the supplements. I told countless people about my experience and they came back and thanked me for telling them. My wife doesn’t tolerate the supplements, so they are not for everyone. For me, however, it just plain works. Must be eating into drug manufactures profits!

* Posted October 18th, 2016 at 5:00 pm

M.A.L. DDS

Since G & C is not injected directly into the bloodstream or joints, what degraded form does it have after digestion and final absorption gastric or intestinally? Has anyone ever done blood analysis to see the levels of circulating G & C (the only way it could get to the joints)? Have any studies been done (animal?) to quantify the increase of G & C in joints after regimens had been administered? I have a feeling that actual scientific studies have been eclipsed by testimonials. One wonders if some may even be related to the companies manufacturing said products.

* Posted October 20th, 2016 at 2:11 pm

Paul Kleiber

Excellent comment. I am a proponent and have been using G & C for over 20 years. BUT, before I started, I thoroughly researched brands and have concluded that the efficacy vary greatly from one to another. I believe the key is in “absorbability”. This goes to what you intimate – what exactly reaches the blood and what remains to be absorbed. If the G & C is unusually inexpensive, it is likely made with cheaper ingredients. I use Cosamin DS from NutraMax Labs. They recently came out with Cosamin ASU with different percentages of G & C and have gone back to the DS after a noticeable difference. Without using the best ingredients available, the studies will always be suspect.

* Posted October 21st, 2016 at 3:10 pm

Laura M

My veterinarian recommended glucosamine chondroitin ASU for arthritis-associated lameness in my elderly horse. After a few weeks of supplementation he was back to his former active self. I have been giving it to him for 7 years, he is over 30 yrs old, and still active. I looked it up online and found a study in the NIH library supporting the effectiveness of GC ASU in relieving pain of arthritis in the knees in humans. I began taking the human version (same manufacturer) and it has almost eliminated the arthritis pain in my knees. I hike, climb stairs, and sleep without pain. I’m sold. GC ASU for humans is available at Costco and online.

* Posted October 17th, 2016 at 9:02 pm

K.E.Watson

a few years ago I fell going upstairs right on my knee cap.

This lead to: limping around for months, doctor assessment of no break, just bruised, and NSAIDS for pain relief.

I found glucosamine sulfate 500 mg which I took 2 times a day.

I had relief when I took them and pain when I did not.

After < 18 mos. I stopped and all is good. I now live never thinking about the fall and have no limp and take no meds.

supplements have a place probably not for all.

* Posted October 17th, 2016 at 8:02 pm

Kieran Jones L.Ac.

I tend to recommend a collagen supplement rather than glucosamine. While the aminos in collagen are non-essential amino acids, I think it is unlikely that all people are making enough of these compounds to serve the routine needs of the skin and gut, the cofactor needs (in the case of glycine), and still have enough left over to support healing a damaged joint. I’ve personally seem encouraging anecdotes in patients I work with.

* Posted October 17th, 2016 at 7:45 pm

Phyllis Wolfe

Several years ago I had terrible pain in my right knee, seemingly out of the blue. I could hardly walk. I contacted the most highly rated knee surgeon in Atlanta at the time. She made an appointment, took an x-ray, and said I was losing cartilage behind my right knee cap. She immediately told me to start taking CosaminDS. It is more expensive but has the stated amount of Chondrotin, which many less expensive brands do not. She also had me do a little physical therapy, but for only a couple of weeks. My pain went away within a few days. I continued the CosaminDS for at least a year, then cut down on the dose and gradually stopped taking it

Now, from hiking too much or doing too many stairs, I feel a some pain in that knee. Then I take the CosaminDS for a few days or a week. The pain disappears so I gradually cut back to no supplement. This has kept me pain free now for 14 years. IF CARTILAGE LOSS IS YOUR PROBLEM, I HIGHLY RECOMMEND TAKING COSAMIN DS.

* Posted October 17th, 2016 at 8:03 pm

emeterio I hurtado

can i take glucosamine sulfate also ??

* Posted October 21st, 2016 at 2:39 pm

Phyllis Wolfe

Sorrry, but I cannot answer that question. I would ask your doctor to research that for you. CosaminDS contains both Glucosamine and Chondroitin, so I would not think you would need more of either, but do check with your doctor .

* Posted October 17th, 2016 at 7:42 pm

Suzanne Marilley

I am a breast cancer survivor. After I started taking Letrozole (generic Femara), I suffered stinging pain in my ankles every morning as I rose from bed. I searched on the internet and found the Cosamin DS recommendations. I phoned my doctor who said that I could try it.

Although this medicine does not vanquish all my joint pain, it certainly took the edge off it, especially in the morning. I take one pill in the morning and one at night. I started taking the pills almost five years ago. I certainly would have had to discontinue taking the letrozole if I had not found some form of relief.

* Posted October 17th, 2016 at 7:15 pm

William

Glucosamine is not independent of joint structure. I had been taking G-C/MSM for years, but finally had to have a hip replacement. It seemed to help, along with other herbal supplements, but did not prevent the loss of cartilage in the joint.

The year after my surgery, my dog started to limp. An x-ray showed he had lost cartilage in his shoulder and neck not unlike my hip. I upgraded his Eukanuba dog food to the “senior” version “with glucosamine.” Wondering what they added, I looked at the ingredients. The glucosamine comes from “processed chicken parts.” Pretty clear that is bones and joints with lots of cartilage.

Sure, we both take a glucosamine supplement (which has relieved his limping), but no bone leaves the house without first being subjected to 12 hours of simmering to make bone broth, for both of us. (Hint: stash bones in a ziplock bag in the freezer until you have a good lot for broth.)

* Posted October 17th, 2016 at 8:04 pm

beaux

What about your dog? Years ago my really-old dog started limping and favoring his left rear leg. I had started taking G/L w/MSM and started giving him half a pill a day. In a period of 2 weeks he returned to “Throw-the ball-now-buster” health. I will never stop the G/L w/MSM.

* Posted October 25th, 2016 at 2:41 am

William

As I said, “we both take a glucosamine supplement (which has relieved his limping).” His vet-prescribed Dasuquin costs more than my glucosamine supplement, but it works! Half a pill twice a day, with peanut butter.

* Posted October 17th, 2016 at 5:55 pm

M A Skeptic

I am not seeing any references to the study mentioned. I wonder if the source of the supplements is known and whether it was ever tested for actual ingredients; most are never tested.

* Posted October 20th, 2016 at 2:19 pm

Paul Kleiber

Exactly. The ingredients are key. I researched G&C before starting over 20 years ago and discovered that how the G&C gets absorbed will make a huge difference. The best, I believe, is Cosamin DS.

* Posted October 17th, 2016 at 5:20 pm

Ian Miller

I have had a hip problem and I tried a glucosamine/chondroitin mix, and it is hard to know whether it worked or not. I felt no adverse effects, but I am shortly going to have a titanium ball and socket to replace my hip parts – the supplements did not solve the joint problem. So, for me, no adverse effects, but no obvious beneficial ones either.

* Posted October 17th, 2016 at 5:08 pm

B Hawkins

Interesting. I started taking Cosamine DS when word drifted back from France about the arthritis relief the supplements were giving- I was about 40 and had a “bad” knee preventing me from doing things. It worked like a miracle, leading me to believe there are some conditions involving joint pain it relieves.

Recently recommended it to a young friend with hip pain- same results!

* Posted October 17th, 2016 at 4:51 pm

Georgia Raysman

My advice–give it time to work.

When I was undergoing chemotherapy 10 years ago for breast cancer, an assistant to my Sloan Kettering oncologist suggested that I try a glucosamine/chondroitin supplement. I’d been complaining bitterly about feeling like a veteran of the Spanish-American war when I tried to get out of a chair or walk around the block–not pain in my joints but just a general creakiness.

I started a regimen of glucosamine/chondroitin supplement but noticed no effect after a month. I tried another combination of both ingredients and again noticed no difference. Finally I tried one more combo–Flexamin Triple Strength–and within a month I realized that gradually my joint creakiness had disappeared and I was completely without symptoms.

It then also occurred to me, though, that it might not have been the Flexamin that did the trick–it might just have been using the product for at least three months.

If people give up on it too soon they may be shortchanging themselves. This may just not be a product that produces instant results, something that we lay people have come to expect, but will gradually help one’s joints become healthier.

* Posted October 17th, 2016 at 4:43 pm

Stephanie

How about the use of glucosamine and/or chondroitin for other reasons? Is this study showing they reduced mortality (obviously, for the study time only, not forever) worth considering? Use of glucosamine and chondroitin in relation to mortality. European Journal of Epidemiology, August 2012, Volume 27, Issue 8, pp 593–603

* Posted October 17th, 2016 at 4:20 pm

Dr. John Minatelli

The US Government sponsored 4-year multi-center GAIT study confirms Dr. Shmerlings observations that glucosamine or chondroitin alone or in combination with each other did not show statistically significant improvement in standardized test scoring over the placebo arms in osteoarthritic patients with the exception that those experiencing the highest diseased joint severity showed some statistically significant relief (see: https://nccih.nih.gov/research/results/gait). In shorter well designed placebo controlled human clinical studies glucosamine alone or in combination with chondriotin showed no better response than the placebo arm. This is why research continues to explore new dietary supplement ingredients to find a suitable product that offers clinically effective joint health relief. The well-known side effects of the prescription drugs available on today’s market for treatment of joint pain limit their utility particularly in chronic use. These include the NSAID drug family as well as the opiates and inject-able or oral steroids. Thus there is a strong need for new safe and effective products for chronic use.

* Posted October 17th, 2016 at 4:17 pm

Philomena Kanouse, Ph.D.

I am a 78 year old female who has taken glucosamine and chondroitin for 38 years. I run 5 miles/day, bike, lift weights and do core exercises. I am convinced that I can still do all of these things without pain – nor any joint replacements – is due to g and c. Perhaps they have worked as a preventative measure vs. curing an existing condition.

* Posted October 17th, 2016 at 4:12 pm

George Miller

I have been taking both in the sulfate form. They work for me. The hydrochloride form does not. When I started, it took about 2 months for any effect. I am 79 and don’t have any joint pair but do have muscular pair.

* Posted October 17th, 2016 at 4:04 pm

Tom mues

I have been taking Triple-Flex for over 20 years. It contains the two mentioned ingredients plus MSM. I will be 75 years old in a few months and I have absolutely no joint pain anywhere in my body. I stopped taking it a few years ago and hard a hard time walking up my driveway. I restarted taking it and the pain disappeared. I do not care what the studies report. I will continue taking it.

* Posted October 17th, 2016 at 3:41 pm

Jung Yoon

when i take glucosamine for my joint pain, i feel a little relief from some pain. but when i combined it with chondroitin, i felt very sick. i discontinued chondroitin. i have been taking only glucosamine for years. i f i don’t take it for a few days, the pain is more than usual–when taking glucosamine. thank

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