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Q. What is Glucosamine (with or without chondroitin) and what does it do?

What is it and how does it work?
Glucosamine is an amino sugar produced from the shells of chitin (shellfish) and is a key component of cartilage. Glucosamine works to stimulate joint function and repair. Each person produces a certain amount of glucosamine within their bodies. When people grow older, their bodies lose the capacity to make enough glucosamine. Having ample glucosamine in your body is essential to producing the nutrients needed to stimulate the production of synovial fluid, the fluid which lubricates your cartilage and keeps your joints healthy. Without enough glucosamine, the cartilage in their weight-bearing joints, such as the hips, knees, and hands deteriorates. The cartilage then hardens and forms bone spurs, deformed joints, and limited joint movement - this is the basis of osteoarthritis issues.
 
Where do I find it, and is it any good?
In the United States, glucosamine and chondroitin products are marketed as "dietary supplements." Glucosamine is available in many forms, including glucosamine sulfate, glucosamine hydrochloride (HCl), and N-acetylglucosamine (NAG), and may also contain a potassium chloride or sodium chloride salt. However, there appears to be no conclusive evidence that one form is better than another.
 
Chondroitin is typically sold as chondroitin sulfate. In December 1999 and January 2000, ConsumerLab.com tested 25 brands of glucosamine, chondroitin and combination products and found that (a) all 10 glucosamine-only products, passed the test but 2 chondroitin-only and 6 out of 13 combination products did not (because their chondroitin levels were too low). In January 2001, one of the combination products was removed because its manganese level was judged to be too high.

In 2001, Consumer Reports evaluated 19 products and reported:

Most . . . were reasonably well standardized, delivering at least 90 percent of the amount of glucosamine or chondroitin promised on the label, thereby meeting a new standard for the supplements proposed by the U.S. Pharmacopeia, which sets standards for drugs and proposes them for supplements. But four products -- Now Double Strength Glucosamine & Chondroitin, ArthxDS Glucosamine Chondroitin, Solgar Extra Strength Glucosamine Chondroitin Complex, and Now Chondroitin Sulfate -- failed to meet that standard. Two products -- Solgar Extra Strength Glucosamine Chondroitin Complex and Twinlab CSA (Chondroitin Sulfate) -- recommended too few pills per day to supply the dose used in the successful clinical trials. Several others listed the recommended number of pills as a range that permits consumers to take a dose that may be inadequate.
Side Effects?
No study so far has found any serious side effects from either glucosamine or chondroitin. The most common side effects are increased intestinal gas and softened stools. However, animal research has raised the possibility that glucosamine may worsen insulin resistance, a major cause of diabetes. So far, studies in humans have not substantiated that risk. Nevertheless, people with diabetes should monitor their blood-sugar level particularly carefully when using that supplement. There have been no reports of allergic reactions to glucosamine. But since it's made from shellfish shells, people who are allergic to seafood should use it cautiously, watching for reactions, or avoid it entirely. As for chondroitin, it can cause bleeding in people who have a bleeding disorder or take a blood-thinning drug.

Respected medical authorities regard use of these compounds as plausible and agree that more research is needed to place them in proper perspective. However, disagreement exists about how practical it is to use them now. The organizations I trust most give different advice..
 
Consumer Reports states:

The long-term safety and efficacy of glucosamine and chondroitin remain unclear. Still, our medical consultants say there's enough evidence to conclude that products containing the amounts of glucosamine, chondroitin, or both that worked in the clinical trials might be worth trying for people with osteoarthritis -- particularly if they've experienced or are likely to experience significant side effects from conventional painkillers. (Those amounts were 1,500 milligrams per day of glucosamine salt -- glucosamine bound to another molecule -- and 1,200 milligrams of chondroitin salt.)

While no one knows which formulation works best, it makes sense to try one of the least expensive combination products, such as Puritan's Pride Maximum Strength Glucosamine Chondroitin or Spring Valley Glucosamine Chondroitin Double Strength; they deliver both of the ingredients at lower cost than the chondroitin-only products and, in most cases, at a similar cost to the glucosamine-only products. For those who are concerned mainly with cost, however, Spring Valley Glucosamine Complex was the least expensive product we tested (although to get the clinical-trial dosage, you need to ignore the range of daily pills recommended on the label and take the maximum, three per day).

It may take two months . . . to produce any significant improvement. If you see no effect by then, it's probably best to try a different approach [6]

The Medical Letter, which is the medical profession's most respected drug advisory publication, is more conservative:

Glucosamine with or without chondroitin may have some beneficial effect on osteoarthritis, and studies up to 3 years in duration have found no more adverse effects than with placebo, but most Medical Letter consultants are sceptical. Whether glucosamine offers any advantages over better established drugs such as acetaminophen, traditional NSAIDS or selective Cox-2 inhibitors remains to be determined. As with other dietary supplements, the quality and purity of the ingredients may vary.

A clinical trial that should add considerably to medical knowledge about glucosamine and chondroitin has been funded and is now recruiting patients. It will be a 24-week, placebo-controlled, double-blind, study that will evaluate the effect on osteoarthritic knee pain of glucosamine hydrochloride, chondroitin, a combination of the two, and celicoxib among 1588 participants at 13 centers throughout the country over a 27-month period. The estimated completion date in March 2005.

So, which one should I buy?
Dietary supplements like glucosamine and chondroitin sulfate are not tested or analyzed by the Food and Drug Administration before they are sold to consumers. That means consumers can’t be sure they’re getting what they pay for when they purchase bottles labeled "Glucosamine and Chondroitin." In fact, a recent study by ConsumerLab.com showed that almost half of the glucosamine and chondroitin supplements tested did not contain the labeled amounts of ingredients. So, please review and pick a previously TESTED product. :-)
http://www.consumerlab.com/results/gluco.asp
http://www.arthritis-glucosamine.net/glucosamine/glucosamine-products.html

Places to read up on Glucosamine:
http://www.arthritis-glucosamine.net/
http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/glucosamine.html
http://www.consumerlab.com/results/gluco.asp

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