Monday, March 17, 2014

Glucosamine Fails to Prevent Deterioration of Knee Cartilage or Decrease Pain

A short-term study found that oral glucosamine supplementation is not associated with a lessening of knee cartilage deterioration among individuals with chronic knee pain.
Tuesday, March 11, 2014

Findings published in Arthritis & Rheumatology, a journal of the American College of Rheumatology (ACR) journal, indicate that glucosamine does not decrease pain or improve knee bone marrow lesions – more commonly known as bone bruises and thought to be a source of pain in those with osteoarthritis (QA).

According to the ACR, 27 million Americans over 25 years of age are diagnosed with OA – the most common form of arthritis and the primary cause of disability in the elderly. Patients may seek alternative therapies to treat joint pain and arthritis, with prior research showing glucosamine as the second most commonly used natural product. In fact, a 2007 Gallup poll reports that 10% of individuals in the US over the age of 18 use glucosamine, with more than $2 billion in global sales of the supplement.

For this double-blind, placebo-controlled trial, Dr. C. Kent Kwoh from the University of Arizona in Tucson, enrolled 201 participants with mild to moderate pain in one or both knees. Participants were randomized and treat daily with 1500mg of glucosamine hydrochloride in a 16-ounce bottle of diet lemonade or placebo for 24 weeks. Magnetic resonance imaging (MRI) was used to assess cartilage damage.

Trial results show no decrease in cartilage damage in participants in the glucosamine group compared to the placebo group. Researchers report no change in bone marrow lesions in 70% of knees, 18% of knees worsened and 10% improved. The control group had greater improvement in bone marrow lesions compared to treated participants, with neither group displaying a worsening of the bone marrow lesions. Dr. Kwoh concludes, “Our study found no evidence that drinking a glucosamine supplement reduced knee cartilage damage, relieved pain, or improved function in individuals with chronic knee pain.”

Glucosamine Sulfate was the first supplement I recommended to patients 38 years ago. Clinically, 80% of my patients with chronic low back pain experienced reduction in symptoms within 30 days. I quickly realized that about half of the patients that did not respond favorably were diabetic.

Today, we have uncovered the chemistry behind glucosamine sulfate. Basically, it requires good glucose metabolism and good sulfur metabolism to function. That explains why my diabetic patients failed to respond. Sulfur metabolism depends on the ability of the body to strip sulfur from sulfur bearing amino acids.

Please read my recent Wisdom Wednesday: Vitamin B6 blog post for information on this process.

The first flaw in this study is the use of glucosamine hydrochloride, not glucosamine sulfate. Without adequate sulfur, the chemistry just doesn’t work. They also failed to identify participants that may have impaired glucose metabolism. As I have frequently written, insulin resistance is epidemic in this country. Finally, glucosamine sulfate, MSM, and chondrotin sulfate all help form ground substance which is necessary to repair connective tissue. None of these chemical are inherently anti-inflammatory in nature. If you do not reduce inflammation first, healing can not occur.

I still use glucosamine sulfate in my practice today. However, I first address inflammation, sulfur amino acid metabolism, and glucose metabolism prior to supplementation. Most of the time, correcting these three chemical pathways solves the problem and direct supplementation of sulfur and glucose in not necessary or desired.

If you want to take one of these supplements, at least take one that contains both glucose and sulfur. Better yet, have your glucose and sulfur metabolism evaluated. A simple blood test, the glycohemoglobin A1c will assess your metabolism of sugar for the past two months. If eating cruciferous vegetables, like broccoli, cauliflower, or cabbage, gives you gas, then your sulfur amino acid metabolism is suspect.