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Chondroitin |
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Chondroitin, in the form of Chondroitin Sulfate, is one of the most commonly purchased supplements for joint health. Studies show that it can relieve some of the symptoms associated with osteoarthritis - such as pain and decreased mobility. Chondroitin is a molecule that is found naturally in humans as well as many other forms of life.
It is part of a group of very large molecules called glycosaminoglycons that are made up of glucoroinic acid and galactosamine. Since they are very large molecules, they are not easily absorbed, and oral bio-availability is usually less than 20%. A major component of cartilage, Chondroitin keeps joints healthy by supplying fluids to joint connective tissue, and providing the necessary building blocks to form new connective tissue.
Chondroitin may also be helpful in blocking enzymes that promote the breakdown of cartilage. Chondroitin is essential for proteoglycan production, collagen production, and hyaluronic synthesis. Each of these compounds is not just important for joint health, but is widely needed throughout the body. Proteoglycan is a type of glycoprotein that is found in the connective tissue of humans. It constantly breaks down and requires constant replacement to keep joints healthy. Collagen is a major source of protein present in the body, accounting for largest % of the protein in the body. It is important for the health of connective tissue in humans. It is also the main component in cartilage, ligaments, tendons, and bones. Hyaluronic synthesis helps to produce Hyaluronic acid, which is important for vision, tissues, prevent bacteria invasions, skin elasticity, circulatory lubricant, and molecular transport. It also helps to relieve joint pain.
Chondroitin is often paired with Glucosamine, another molecule naturally found in the body. Together the two molecules work to constantly rebuild cartilage. It is the most abundant glycosaminoglycan found in cartilage and is used to maintain the resiliency of cartilage. Currently it is thought that it may be a very effective treatment for osteoarthritis. In studies it has been known to reduce the pain associated with OA and may actually slow the progression of the disease.
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Chondroitin was isolated from cartilage by Fischer & Boedecker in 1861. It wasn't until the 1930s that Meyer began research on the compound. In 1947, it was studied by Prof. Fujio Egami at Tokyo University to combat headaches. By 1955, Zeria tablets produced by Kaken Yaku were widely accepted. Chondroitin powder Z was released in 1959 and by 1963 a prescription version, the Z tablet was introduced and in 1963 an over-the-counter version, Chondroitin ZS tablets were put on the market.
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Chondroitin is well known for its ability to treat patients with osteoarthritis and has been studied since the 1980s for this use. Many of the studies reported significant improvement of symptoms of osteoarthritis including: pain, mobility, and inflammation. Unfortunately many of the studies have been relatively short, from 6 months to 24 months - leaving room for questions about Chondroitin’s long term benefits. However, despite this weakness the scientific evidence clearly illustrates the effectiveness when Chondroitin is used from 6-24 months. Studies have suggested that Chondroitin supplementation may be useful to treat osteoarthritis of the knee or hip. Studies have found that Chondroitin reduces pain, improves mobility, reduces swelling and stiffness, and can provide relief from symptoms for up to 3 months after treatment has ended.
The largest clinical trial to date was the 2006 Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). It was sponsored by the National Institutes of Health and resulted in conflicting and confusing results. The study involved approximately 1,600 people who suffered with osteoarthritis of the knee. Overall, the study found that Glucosamine and Chondroitin did not reduce pain for all individuals, but it did seem to lessen it in people with moderate-to-severe osteoarthritis of the knee (as well as improving their overall quality of life).
Chondroitin therapy has been used to treat: allergies, Alzheimer's disease, angina, ulcers, headaches, HIV/AIDS, diabetes, iron-deficiency (anemia), kidney stones, leukemia, breast cancer, rheumatoid arthritis, cardiovascular disorders, torn ligaments and tendons, wounds, and broken bones. Chondroitin has also been used as a preventative to premature births, as well as an anticoagulant and anti-inflammatory agent.
There have been many studies on Chondroitin, especially when it comes to treating osteoarthritis. Below is a list of studies that have been done to prove the efficiency of Chondroitin in treating common ailments such as: osteoarthritis, Alzheimer’s disease, premature labor, and the nephrotoxicity of cisplatin (kidney toxicity symptoms in bladder cancer).
In addition to being used in humans, Chondroitin can also be used on cats and dogs to help with similar disorders of the joints, stomach, and skin. Humans, cats, and dogs can experience joint conditions like hip dysplasia - a condition where all smooth cartilage cushioning the movement of bones wears away, and the sufferer ends up with painful bone-to-bone contact.
Osteoarthritis/Arthritis and Joint Health research:
Bourgeois P, Chales G, Dehais J, et al. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3 x 400 mg/day vs placebo. Osteoarthritis Cartilage. 1998;6(suppl A):25-30.
Chavez ML. Glucosamine sulfate and chondroitin sulfates. Hosp Pharm. 1997;32(9):1275-1285.
Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808.
Das A, Hammond TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage. 2000;8(5):343-350.
Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999;25:379-395.
Alzheimer’s Disease:
Goedert MR, Jakes R, Spillantini MG, et al. Assembly of microtubule-associated protein tau into Alzheimer-like filaments induced by sulphated glycosaminoglycans. Nature. 1996;383:550-553.
Premature Labor:
Obara M, Hirano H, Ogawa M, et al. Does chondroitin sulfate defend the human uterine cervix against ripening in threatened premature labor? Am J Obstet Gynecol. 2000;182:334-339.
Nephrotoxicity of Cisplatin:
Zhang JS, Imai T, Otagiri M. Effects of a cisplatin-chondroitin sulfate A complex in reducing the nephrotoxicity of cisplatin [abstract]. Arch Toxicol. 2000;74(6):300-307.
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Sources and Forms of Chondroitin: |
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Chondroitin is naturally produced in the body but can also be found in the shells of shellfish. Additional natural sources include: shark cartilage, beef cartilage, and bovine trachea. Chondroitin Sulphate is the most common form of Chondroitin available in supplements. Today Chondroitin supplements come from both natural and synthetic sources - and the growth of demand for joint health supplements has led to some questionable sources of Chondroitin.
In a recent independent test (Consumer Labs) of quality, 37 joint supplements were tested and 8 supplements failed testing standards. Four had less than 8% of their listed amounts of key ingredients, including a "maximum strength" product that contained no Chondroitin at all. Three others had only 52% to 75% of listed ingredients. One supplement failed testing parameters because it would not properly break apart to release its Glucosamine and Chondroitin.
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Recommended Dosage of Chondroitin: |
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It is nearly impossible to ingest enough Chondroitin through diet, so supplementation is necessary to treat conditions such as osteoarthritis. Chondroitin Sulfate has little bio-availability (it is difficult to absorb into the system), and so large amounts are needed in order to acquire any benefits.
Chondroitin has not been approved for children. Adults can take (orally) 200-400 mg 2-3x/day or 800-1200 mg once a day. Larger doses up to 2000 mg seem to work effectively also. When treating ailments such as osteoarthritis, several weeks are needed before benefits can be seen. For treatment of osteoarthritis, 50-100 mg per day via injection has been shown to be effective.
Always discuss with your doctor before beginning any supplement therapy.
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Safety and Side Effects of Chondroitin: |
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Overall studies have shown that Chondroitin Sulphate is well tolerated, with most side effects being mild. Caution is advised for individuals allergic or hypersensitive to shellfish. Side effects that may occur include: hives, rash, sun sensitivity, and possible worsening of asthma.
Other rare, adverse effects include: headache, motor difficulties, euphoria, photo-sensitivity, hair loss, chest pain, elevated blood pressure, edema (swelling caused by an overabundance of liquid) of the lower extremities, stomach pain/dyspepsia, nausea, diarrhea, constipation, transaminitis (liver damage), increased bleeding, bone marrow suppression, and edema of the eyelids. Individuals with (or at risk of) prostate cancer should avoid Chondroitin, as Chondroitin has been known to increase spread rate of the disease and increase the recurrence of cancer.
Pregnant individuals should also avoid taking Chondroitin as it has effects as heparin, a blood thinner. If you are currently taking anticoagulants (blood-thinners), you should avoid consuming Chondroitin supplements as it can increase the effects of your blood-thinning medications.
Often NSAIDs (Non-steroidal anti-inflammatory drugs) are taken to relieve the pain of osteoarthritis. Chondroitin may increase the effectiveness of NSAIDS, causing you to take a lower dosage. This can be beneficial, as NSAIDs can lead to bleeding of the stomach.
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Frequently Asked Questions on Chondroitin: |
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Do chondroitin supplements increase cartilage formation?
Unfortunately, studies have not proven that the oral consumption of chondroitin alters the availability of cartilage building materials inside an already arthritic joint. Consumption of these supplements has also not been proven to increase the quantity of cartilage building materials in any joint. However promising studies continue on this matter.
Conn D, et al. Alternative Treatments and Rheumatic Disease. Bulletin on the Rheumatic Diseases. 1999;48:1-4.
What kinds of research has been conducted on chondroitin?
There have been many studies that have examined treatment with chondroitin over short periods - many lasting only one or two months. Though the studies have been short in duration, the subjects consistently experienced a reduction in pain versus those administered a placebo. Reduction in pain on Chondroitin has been comparable to reduction on NSAIDS.
NSAID side effects can include stomach ailments and bleeding, while Chondroitin has very few side effects. This makes Chondroitin preferred for treatment of osteoarthritis. Studies have also proven that NSAIDs may actually stimulate progression of arthritis, but Chondroitin may have a protective effect and may actually slow progression of the disease.
Muller-Fasbender H, et al. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2:61-69.
Should I be taking chondroitin?
Results from the numerous studies are promising, although further research is needed to sufficiently prove efficacy. Chondroitin is currently classified as a supplement and is therefore unregulated - supplement quality tends to differ from brand to brand. It is always best to consult your physician before beginning any supplementation program. Currently, there are alternative ways to effectively treat osteoarthritis such as: weight loss, exercise, proper medication use, and joint protection life-style changes. These options should all be considered prior to starting any supplementation program.
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Additional Research on Chondroitin: |
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Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Alt Med Rev. 1998;3(1):27-39.
Leeb BF, Schweitzer H, Montag K, et al. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000;27:205-211.
McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000;283(11):1469-1475.
Morreale P, Manopulo R, Galati M, et al. Comparision of the anti-inflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol. 1996;23:1385-1391.
Ronca F, Palmieri L, Panicucci P, et al. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage. 1998;6(suppl A):14-21.
Towheed TE, Anastassiades TP. Glucosamine and chondroitin for treating symptoms of osteoarthritis. JAMA. 2000;283(11):1483-1484.
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