There have also been reports directly comparing glucosamine
to the effects of ibuprofen. Glucosamine sulphate was at least
equivalent to ibuprofen, and in one case outperformed it (see
ref. 13-14). A study regarding glucosamine hydrochloride (the
other available chemical form of glucosamine in the treatment
of osteoarthritis) in 118 people showed an equivalent reduction
of discomport to ibuprofen treatment15. Only one paper has
previously looked at whether glucosamine might improve the
structure of an osteoarthritic joint16. This paper by Drovanti
showed an improvement in structure of cartilage in those treated
with glucosamine than those on placebo. Unfortunately only
four patients out of the eighty studied had cartilage available
for review by electron microscopy. More recently there has
been the report by Reginster5 involving 212 patients over
3 years that showed a minimal deterioration in joint space
in patients treated with glucosamine. This study relied on
x-rays to demonstrate the reduction in joint space, rather
than electron microscopy used in the previous study. The result
of Reginster's study suggests glucosamine may have a significant
role in joint protection, or chondroprotection. There was
also an improvement in the symptoms of osteoarthritis using
a pain scale. This is the first major long term study evaluating
the efficacy of glucosamine. Prior to this the majority of
studies were between 3 to 8 weeks in duration, which is an
inadequate time to show a significant improvement in the structure
of a joint. Assessment of the cartilage was made by image
analysis of x-rays taken at baseline, 1 year and 3 years using
a digitalised radiograph. This showed the deterioration in
the osteoarthritic joint treated with glucosamine was 0.06
mm. The deterioration in joint space loss in the placebo group
was 0.31 mm. When these figures were analysed statistically,
this was found to be significant.
Glucosamine has been viewed as a safe natural product that
is well tolerated. There have been few side effects on glucosamine
when compared to placebo treatments, which has long been seen
as an advantage over the NSAIDs. These side effects have mainly
been gastrointestinal in nature. These included dyspepsia,
abdominal pain, diarrhoea, as well as fatigue, headache, dizziness
and depressed mood5. There were also reports of photosensitivity,
increases in blood pressure, small amounts of protein leaking
in the urine and an elevation of a muscle enzyme called creatine
phosphokinase. All of these changes were reversible on stopping
glucosamine6. Since glucosamine is a sugar, the question of
whether it can precipitate or aggravate diabetes has been
raised. Animal studies have shown glucosamine affects glucose
metabolism when infused directly into the blood vessels, resulting
in insulin resistance7-8. The concentrations used were higher
than that usually achieved by swallowing oral glucosamine.
In our experience, ceasing glucosamine treatment in poorly
controlled diabetes did not result in better glucose control.
There are no formal studies involving diabetes and osteoarthritis.
The American Arthritis Foundation have recommended that diabetics
perform home blood glucose monitoring more frequently when
on glucosamine, in order to detect changes in the control
of diabetes earlier, and to adjust medications sooner.
There are still unanswered questions about glucosamine. These
include what is the recommended daily dosage and which chemical
form is more effective. The reports on the internet suggest
glucosamine hydrochloride provides the same benefit in protecting
the joint as glucosamine sulphate. The medical literature
is not clear. The study by Reginster only used glucosamine
sulphate. There have been reports that glucosamine hydrochloride
was not as effective, but results in these studies were conflicting15,17.
The evidence is not yet in on whether glucosamine creams are
as effective in the easing of joint discomfort.
Continue
to Page 3 of this Article
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Be sure to visit the Glucosamine Product Guide for a review of commercially available glucosamine products broken down by 9 different categories such as price per month, quality and type. Learn what the best products out there are and what criteria was used to ranked each.
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