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.”

MY TAKE:
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.

THE BOTTOM LINE:
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.

Wisdom Wednesday: Vitamin B6

Vitamin B6 is part of the vitamin B complex. It is found in flesh foods, starchy vegetables, and many fruits. Like folic acid, it is involved in more than 100 chemical pathways in the body as an enzyme. Enzymes catalyze (facilitate) chemical reactions in living systems.

B6 often works with folic acid and vitamin B12 in those pathways. For example, sulfur bearing amino acids found in cruciferous vegetables (like broccoli, cauliflower, and cabbage) are stripped of their sulfur for use throughout the body. Vitamin B12 and folic acid initially create homocysteine then B6 takes over and through several steps, the sulfur is freed.

High levels of homocysteine in the blood stream increase plague formation and it is associated with an increased risk of heart disease. I routinely test homocysteine to access coronary risk, but more basically to gauge sulfur amino acid metabolism and vitamin B6 status.

The freed sulfur is used to make glucosamine sulfate, chondrotin sulfate, and MSM; all necessary to repair connective tissue in the body. These popular supplements are dependent on vitamin B6 metabolism.

The sulfur is also used in phase II liver detoxification. Phase II detox is where all the man made chemicals, drugs, exogenous hormones, and other pollutants in the body are eliminated. There are 10 potential pathways and sulfur is required for 5 of them to function. In earlier times, alcohol and our own hormones were the only chemicals cleared from the body through these pathways.

Additionally, sulfur is used in the bowel to control Candida and other potential parasites.
Although vitamin B6 is abundant in food, the body can not use the food form. Like folic acid, it must be converted in the lining of the small intestine to its bio-available form pyridoxine 5-phosphate. Again, just like folic acid, 8% of the population is genetically impaired and can not make that conversion while 25% have the genetic impairment from just one parent.

Frank deficiency of vitamin B6 will create cracks in the corners of the mouth and on the tongue. Because it is involved in so many chemical pathways in the body, small deficiencies can create a myriad of symptoms.

THE BOTTOM LINE:
Have your homocysteine measured as part of your yearly lab work. If you develop a lot of gas when eating cruciferous vegetables, your sulfur amino acid pathways are not functioning well and you may have a B6, folic acid, or B12 deficiency. If you take glucosamine sulfate, MSM, and/or chondrotin sulfate without apparent benefit you are either insulin resistant or have impaired sulfur amino acid pathways.