Glucosamine - and that other good stuff
I have found myself recommending the benefits (now proven) of taking some form of supplements to support joints to loads of our patients here at C1 Chiropractic Health Centre and I thought a summary might help get the message out and clarify understanding.
What should you take?
What you are after is called glucosamine and chondroitin. This stuff is described as the ‘cement of the connective tissues’. These connective tissues include the cartilage that covers the ends of your bones which acts as a shock absorber and helps the joint move smoothly.
Chondroitin
Chondroitin is produced mainly from shark cartilage extract. Unfortunately there is huge inconsistency in the concentrations of chondroitin extracted from this source, so its benefits are somewhat dubious and no conclusive studies are available at present. Helpfully, the body manufactures its own chondroitin from glucosamine and so its addition to your supplement is probably unnecessary.
Why should you take a supplement?
The matrix that your cartilage is built from is relatively inert stuff, it has little or no direct blood supply and a few cells to keep it maintained. The stuff itself is not widely available in your diet and it is not well absorbed by the body. If you damage your joints or they are suffering ‘fair wear and tear’ then this cartilage will be damaged. If this occurs the body tries to repair it but with little of this building material available. The idea behind supplements is that you make sure that your body has enough of the stuff to allow the cells in the cartilage matrix to effectively repair the cartilage.
Which type of Glucosamine is best?
If you don't have a shellfish allergy D-Glucosamine Sulphate 2KCl is the stuff. This is manufactured from shellfish.
If you do have a shellfish allergy D-Glucosamine Hydrochloride (HCl), which is synthesised from a protein taken from shellfish, is the stuff for you. Generally speaking, shellfish allergy is caused by other constituents within the shellfish, not the protein!
Powder v Liquid v solid
Glucosamine is available in the following forms:
• Pure Powder
• Capsules
• Tablets / Caplets
• Liquid (Joint Formulas)
Pure powder is the best option – mixed with liquid of your choice, it is the most bioavailable and economical.
Liquid joint formulations are best for absorption however you are often paying for the suspension liquid when it's the Glucosamine that does the job.
Tablets – you are paying for the ‘binding and bulker’ in the tablet and they can pass straight through.
Capsules without any bulking ingredients or flow agents are good.
So it's best to buy pure powder and add it to a liquid of your choice however this may not be available and any is better than none.
And where possible they should contain HCL and Sulphate
How much should you take?
The recognised dosage for Glucosamine is 1,500mg per day but evidence has shown that:
If you weigh less than 180 lbs take 1500 mg/day
If you weigh more than 180 lbs take 2000 mg/day
This can be taken either in one dose ie 1,500mg or split in to three equal doses ie 500mg three times a day.and it is best with food.
What does it taste like?
Glucosamine Hydrochloride (HCl) is naturally sweet tasting with a hint of bitterness - hard to describe but not at all unpleasant.
Glucosamine Sulphate 2KCl tastes sweet and very slightly fishy! Something like very, very mild prawn cocktail crisps, again with a touch of bitterness.
Glucosamine Sulphate NaCl tastes slightly salty and fishy.
Side Effects
Allergic reactions to this supplement appear to be rare. At the suggested adult dosage of 1,500mg per day, adverse effects have been limited to mild, temporary gastrointestinal upset e.g. mild nausea, vomiting, constipation, diarrhoea and dyspepsia, and, rash, drowsiness, headache and insomnia. In one trial, people with peptic ulcers and those taking diuretic drugs were more likely to experience side effects. (Ref 1)
In 1999 the first case of an allergic reaction to oral Glucosamine Sulphate was reported (Ref 2). .
Pregnant or Lactating Mothers - should not to be used by women who are pregnant or breastfeeding due to lack of data on long-term safety.
If you have a reaction or one of the symptoms mentioned above, stop taking the supplement and consult your G.P.
Links with Diabetes
People with diabetes should consult with a doctor and have blood sugar levels monitored if they are taking glucosamine.
Animal research has suggested the possibility that glucosamine could contribute to insulin resistance (Ref 3,4). Theoretically, this could result from the ability of glucosamine to interfere with an enzyme needed to regulate blood sugar levels (Ref 7). However, available evidence does not suggest that taking glucosamine supplements will trigger or aggravate insulin resistance or high blood sugar (Ref 8). Two large, 3-year controlled trials found that people taking Glucosamine Sulphate had either slightly lower blood glucose levels or no change in blood sugar levels, compared with people taking placebo. (Ref 9,10)
Until more is known, people taking glucosamine supplements for long periods may wish to have their blood sugar levels checked.
High Blood Pressure
Some Glucosamine Sulphate is processed with sodium chloride (salt), which is restricted in some diets (particularly for people with high blood pressure).
Contraindications
At the time of writing, there are no known drug interactions with glucosamine.
Alternatives to Glucosamine
If you've tried the different forms of Glucosamine and they didn't suit you then try MSM (Methylsulfonylmethane). MSM has a much smaller, biologically active sulphur molecule than any of the glucosamines and rarely causes an allergic reaction!
Natural pine tree source MSM is highly bio-available according to radio-labelled studies. Again, it's important to check the source as most MSM is manufactured from petrochemical source
Recommended Manufacturers
www.a1msm.co.uk
180g Bio-Pure D-Glucosamine Sulphate (2KCl) powder – @ £17.95 which should last for a month and so works out at about £4.48 a week.
Distilpure natural pine tree source MSM.
www.alimentnutrition.co.uk
Two good products:
Ultimate Glucosamine and Chondroitin Effervescent @ about £11.89 for 30 sachets so £2.77 a week (with 200% RDA for Vit C as a bonus)
Liquid glucosamine @ £4.95 a bottle so £1.75 a week (and 100% RDA for Vit C)
References
1. Tapadinhas MJ, Rivera IC, Bignamini AA. Oral glucoseamine sulfate in the management of arthrosis: report on a multi-centre open investigation in Portugal. Pharmatherapeutica 1982;3:157-68.
2. Matheu V, Bracia Bara MT, Pelta R, et al. Immediate-hypersensitivity reaction to glucosamine sulfate. Allergy 1999;54:643-50.
3. Virkamaki A, Daniels MC, Hamalainen S, et al. Activation of the hexosamine pathway by glucosamine in vivo induces insulin resistance in multiple insulin sensitive tissues. Endocrinology 1997;138:2501-7.
4. Rossetti L, Hawkins M, Chen W, et al. In vivo glucosamine infusion induces insulin resistance in normoglycemic but not in hyperglycemic conscious rats. J Clin Invest
1995;96:132-40.
5. Houpt JB, McMillan R, Wein C, Paget-Dellio SD. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol 1999;26:2423-30.
6. Drovanti A, Bignamini AA, Rovati AL. Therapeutic activity of oral glucosamine sulfate in osteoarthritis: a placebo¬controlled double¬blind investigation. Clin Ther 1980;3:260-72.
7. Barzilai N, Hawkins M, Angelov I, et al. Glucosamine-induced inhibition of liver glucokinase impairs the ability of hyperglycemia to suppress endogenous glucose production. Diabetes 1996;45:1329-35.
8. Russell AI, McCarty MF. Glucosamine in osteoarthritis. Lancet 1999;354:1641; discussion 1641-2 [letters].
9. Rovati LC, Annefeld M, Giacovelli G, et al. Glucosamine in osteoarthritis. Lancet 1999;354:1640; discussion 1641-2.
10. Reginster JY, Deroisy R, Rovati L, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001;357:251-6.
11. Vaz AL. Double¬blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthritis of the knee in out¬patients. Curr Med Res Opin 1982;8:145-9.
