glucosamine, chondroitin, knee pain, arthritis, celecoxib, New England Journal

Glucosamine: Will It Help Arthritis Sufferers?

Glucosamine: Will It Help Arthritis Sufferers?

© 2006 Wellness Clubs of

A February 23, 2006 New York Times’ headline was typical of many that week. It read, “Supplements Fail to Stop Arthritis Pain, Study Says”. The article began, “Glucosamine and chondroitin sulfate, which had sales of $734 million in 2004, do not effectively soothe the knees, a study found.”

Online, the headlines were the same: “U study finds popular dietary supplement ineffective in arthritis pain”, “2 Arthritis Drugs are Found to be Ineffective”, and “Glucosamine ineffective for knee arthritis”. The articles generally began, “Glucosamine hydrochloride and sodium chondroitin sulphate, widely touted by 'alternative' practitioners for relief of arthritic pain, are of no use in treating osteoarthritis of the knee, say US researchers.”

The study behind the headlines was published in the prestigious New England Journal of Medicine. The researchers’ conclusions read, “Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee.”

So it is now scientifically proven that glucosamine supplements are worthless and that people are wasting over $700 million on them each year. Or is it? How was the study designed, and what were the actual results? The fact that numerous studies have demonstrated the benefit of glucosamine in arthritis should at least raise suspicion about the validity of this “definitive study”.

Before examining the actual study findings, flaws in the design of the study need to be pointed out. The first relates to the form of glucosamine used in the study.

Dr. Robert Preston, a gifted formulator of nutritional products, was insistent that specific types of nutrients be used in his products. He had arrived at this position through personal experience. One day a salesman appeared at his office with a new product. The literature was very impressive and Dr. Preston began to recommend it to those patients for whom it was expected to be of benefit. Unfortunately, the results Dr. Preston saw in his practice fell far short of his expectations.

In an attempt to identify why his patients were not responding as predicted, Dr. Preston obtained a copy of the original research paper upon which the product was based. He learned that the form of the nutrient used in the study was different from that used in the manufacturing of the product. Both used the same nutrient, but one form was effective and the other was not. Dr. Preston used this example to explain the difference: If a car is designed to run on 91 octane premium fuel, how many gallons of 87 regular must be placed in the gas tank to get it to run optimally? The answer, of course, is that no amount of 87 octane fuel will produce the results achievable with 91 octane.

Different forms of glucosamine are available. The form used by nearly all nutritionally minded practitioners is glucosamine sulfate. This is because sulfur is an important nutrient needed by the body to repair and maintain joint cartilage. The investigators in this study did not use glucosamine sulfate. They chose to use glucosamine hydrochloride, “because it was the only pharmaceutically available form.” (That statement should say something about relying upon pharmaceutical companies as sources of nutritional products.)

No one who understands the role of sulfur in joint health would expect glucosamine hydrochloride to be as effective as glucosamine sulfate. Unfortunately, medical doctors have little understanding of how nutrients affect the body’s ability to repair and maintain itself. The study was not a quantitative one, which is to say that it did not ask the question, “Does glucosamine provide greater pain relief than a placebo?” The “end point” was a 20 % reduction in joint pain. If someone in this study taking a placebo reported a 20 % reduction in pain and a person taking glucosamine reported a 90 % reduction in pain, the results were recorded as providing an equal benefit.

Even given these glaring design flaws, the actual results belie the investigators’ conclusions. Sixty percent of the people taking placebo pills reported at least a 20 % reduction in knee pain. (This is not difficult to achieve when dealing with mild pain.) Sixty-four percent of individuals taking glucosamine alone reported at least a 20 % reduction in pain. Sixty-five percent of those given chondroitin sulfate (which provided sulfur) reported that level of relief, and sixty-seven percent of people given a combination of glucosamine and chondroitin sulfate achieved the minimum level of pain relief.

While the percentage of people reporting relief was greater than that of the placebo in each case the numbers were “not statistically significant” and considered equivalent. Seventy percent of people with mild arthritic pain who received the drug, celecoxib (Celebrex) reported at least a 20 % reduction in pain. While the glucosamine/chondroitin sulfate group and the celecoxib group were separated by a mere 3 percentage points (67 % and 70 %), the drug was heralded as effective and the supplements were declared ineffective. It should be noted that the difference between celecoxib and the supplements was “not statistically significant”, but was, in violation of their own rules, reported as being meaningful by the investigators. Had they chosen, they could have concluded, “Glucosamine/chondroitin sulfate was shown to be as effective as celecoxib in relieving knee pain.”

For patients who entered the study reporting moderate to severe pain, however, the results were astounding! Four out of five individuals with moderate to severe knee pain reported at least a 20 % reduction on the glucosamine/chondroitin sulfate combination as opposed to only fifty-four percent of those on a placebo. (It is more difficult to achieve a 20 % reduction in severe pain with a placebo.)

That a supplement which was found to bring relief to 79 % of individuals with moderate to severe arthritis pain is reported to be ineffective is an outrage! The study’s design and conclusions say much more about the pharmaceutical bias of the investigators and the United States’ news media than the products under investigation.

While I believe the results of the study, flawed as it was, reinforce the effectiveness of glucosamine and chondroitin sulfate in managing osteoarthritis, it is important to understand that much more can be achieved. I have not recommended glucosamine sulfate alone in the treatment of arthritis for many years.

Omega-3 fatty acids, which are found in fish oils, are needed to provide the raw materials the body needs to manufacture anti-inflammatory compounds. Hyaluronic acid is needed to nourish the cartilage and improve the viscosity of joint fluid. Trace minerals such as copper and zinc must be provided. As a minimum I recommend that individuals who have developed arthritic joints take 4,000 mg. of natural EPA fish oil daily in concert with a comprehensive arthritic support product (AR Formula). When the proper balance of nutrients is provided, nearly everyone is able to obtain relief of their arthritic pain. More importantly, the body is able to maintain the remaining joint cartilage, dramatically slowing the progression of the disease. I have even seen improvement in joint function over time.

The recent glucosamine study once again demonstrates the importance of looking beyond the headlines. The data collected often support conclusions far different from those drawn by the study’s authors and reported in the general media.

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