Glucosamine and Chondroitin Sulfate
Glucosamine and Chondroitin Sulfate- Doctor Biehl's Opinion
Millions of Americans suffer from osteoarthritis, an often painful condition in which the cushioning cartilage between bones wears away. Many people are trying new therapies and dietary supplements such as glucosamine and chondroitin sulfate in their search for pain relief.
Many patients have asked Dr. Biehl about Glucosamine and Chondroitin Sulfate. This brings up important issues about practicing medicine in general. First, it is a good rule of thumb not to be the patient using any product. 90% of the time the new product proves to be more expensive and less useful than an existing product. It is difficult to evaluate new products in medicine because physicians have to wade through fact and fiction. Many products are marketed by companies that stand to make a great deal of profit if their product is used. The companies will pay for "studies" to back their products. It is similar to a used car salesman describing a used car he is selling. The "good" salesman will be overly optimistic. He will enhance the good points of the car and neglect to point out its short comings. He would be considered a "poor" salesman if he pointed out that the used cars down the street were in better condition and sold at a better price. Once the used car is bought, the car's short comings come to light and we may regret that we did not purchase the other car down the street. Unfortunately, the public and physicians are heavily marketed to by drug and medical companies. As a physician, Dr. Biehl reviews all studies with a grain of salt. Some "studies" are paid for and performed by the very company that will benefit from the sale of the product. Many times those type of "studies" should be considered extremely biased to the point that they are not even worth reading. Other studies that are done by independent researchers should be considered much more believable. Personal experience is much more reliable than research articles. Sometimes Dr. Biehl will call up his friends and ask them how their patients have been doing with a new product. He has come to know certain salesmen that will give him a true appraisal of their new product and other salesmen that are full of bull. In any event, Dr. Biehl is extremely knowledgeable about recent scientific data and will use his expertise to best treat his patients.
Glucosamine and Chondroitin sulfate are found naturally in the body. Over-the-counter supplements sold in health-food stores and pharmacies are derived from animal products. People who use these nutritional supplements hope that they will relieve the pain of osteoarthritis, and perhaps even repair or restore the joint cartilage. Recent evidence seems to support the first claim. Both glucosamine and chondroitin sulfate have been used in Europe for several years, with few reported side effects. Both supplements also have some anti-inflammatory effects that may account for the pain relief. That means that they have some activity simi liar to advil or other NSAIDS. But there is no proof that either substance, taken singly or in combination, will actually slow the degenerative process or restore cartilage in arthritic joints. Most studies done to date have been short and focused on pain relief. A recent 1583 patient multi center, double-blind, placebo- and celecoxib-controlled study, was reported in the New England Journal of Medicine (N Engl J Med. 2006 Feb. 23;354(8):795-808) "Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis" concluded: Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain.
Dietary supplements like glucosamine and chondroitin sulfate are not tested or analyzed by the Food and Drug Administration before they are sold to consumers. This concerns Dr. Biehl because that means consumers can't be sure they're getting what they pay for when they purchase bottles labeled "Glucosamine/Chondroitin." In fact, a recent study by ConsumerLab.com showed that almost half of the glucosamine/ chondroitin supplements tested did not contain the labeled amounts of ingredients.
If you're considering taking nutritional supplements to help your arthritis, you may want to consider:
1. Doing some research first. Find out about the supplement you are considering buying. Are there any side effects? Will it interact with your current medication? Write to the manufacturer and ask for documentation that supports their claims. For additional information on glucosamine, check the web site for the
2. Stick with a reputable manufacturer. Because these products are not regulated, consumers are on their own. Even products labeled "standardized" don't meet outside standards, just internal ones set by the manufacturer. Standards can vary among manufacturers, so avoid brand names you don't know.
3. Ask your friends if the product worked for them. Make sure they don't sell the produce themselves.
4. If anything does go wrong and you experience some adverse side effects, stop taking the product.
Dr. Biehl has had many patients try glucosamine and chondroitin sulfate. It has been his experience that many patients feel that the supplements might be helping at first, but after several months, the patients no longer appreciate any benefit. However, there have been very few side effects reported with glucosamine and chondroitin sulfate. Bottom line- it is very rare to find a patient that has had significant long lasting pain relief with these supplements. Therefore, Dr. Biehl does not recommend these supplements. However, if a patient wants to give them a try, he will not disapprove of their use.