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Glucosamine |
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Among the best joint supplements available in the market, glucosamine tops the list. Glucosamine, in conjunction with chondroitin, is best known to improve joint health as it has minimal side-effects along with high effectiveness. As the name implies, glucosamine consists of glucose and an amino acid (a basic building block of proteins). Hence, it is an amino sugar and like any other amino sugar, it is used in giving structural shape and stability to body tissues.
It forms the basic ingredient of proteoglycans, the key component of cartilage. Proteoglycans act as sponges to contain water that is necessary for the smooth movement of the joints. Glucosamine induces the synthesis of glycosaminoglycans which in turn, stimulates the production of cartilage. Apart from cartilage, glucosamine is also needed for the formation of blood vessels, heart valves, hair and nails, ligaments, bones, tendons, synovial fluids and mucus secretions of the digestive, respiratory and urinary tracts.
Two different types of glucosamine, chitin and chitosan, can be found in: crustacean and arthropod exoskeletons, fungi cell walls, and in many other higher organisms. The exoskeletons of crustaceans and arthropods are the common commercial sources of glucosamine. Another, more expensive form of glucosamine is obtained by fermentation of grains like corn and wheat.
Glucosamine has been commonly implicated in treatment and cure of arthritis. Glucosamine slows the progression of arthritis. Several studies have shown that glucosamine actually helps build stronger joint cartilage, all while reducing the rate of destruction of cartilage. Without glucosamine, there would be no proteoglycans and glycosaminoglycans, and hence the formation of proper bones, nails, ligaments, tendons, cartilage, mucus membranes and other tissues would be impaired. Normally, our body produces enough glucosamine to cater to its needs, though aging can lead to a decrease in natural internal synthesis of glucosamine - increasing the need for external supplementation.
Glucosamine is naturally synthesized in the body from glucose and the amino acid glutamine. Glucosamine taken orally is absorbed by the gastrointestinal tract, it is for the most part directed to the joints for new cartilage synthesis. Your body utilizes glucosamine to produce proteoglycans, which in turn, help restore healthy joints. The proteoglycans then trap water to give joints a shock-absorbing bouncing and springing effect. In osteoarthritis, proteoglycans decrease and the water it contains decrease, leading to an inability of the joints to move smoothly. Also, glucosamine prevents the rapid degradation of proteoglycans in the cartilage even before new proteoglycans are synthesized. Additionally, glucosamine has an anti-inflammatory effect on the joints.
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Glucosamine was first identified by Georg Ledderhose in 1876. However, its exact structure and function was known only in 1939 with the work of Walter Haworth. Glucosamine sulfate, an edible form of glucosamine, was first synthesized in 1898. The role played by glucosamine in joint health was first reported almost 50 years ago, when it is was discovered that addition of glucosamine to cartilage cells in a petri dish lead to secretion of glycosaminoglycans and collagen.
The first report of glucosamine as a treatment for human arthritic patients came in 1969. In Germany, an injectable form of glucosamine was used to reduce pain and improve joint mobility.
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Glucosamine is necessary for construction of healthy and strong connective tissue and cartilage in the joints. It is the basic component of proteoglycans that provide buffering action and protect the joints from wear and tear arising out of regular movement. Glucosamine eliminates proteoglycan-destroying enzymes and stimulates the body to produce more proteoglycans.
Glucosamine also reduces joint pain and swelling. This anti-inflammatory property of glucosamine has been exploited to relieve arthritic joint pains, injuries and wounds. Currently, glucosamine is being marketed as a supplement in drinks and juices for strengthening the joints.
Glucosamine also increases the water content of cartilage. It also increases the viscosity of synovial fluid that acts as a lubricant for efficient joint movement.
In addition to stimulating production of proteoglycans, glucosamine also induces synthesis of collagen, the component responsible for rendering strength to bones.
Glucosamine is also being increasingly used in therapeutic and medical devices. Glycosaminoglycans that contain N-acetyl glucosamine are being widely used to control internal bleeding at vascular sites during cardiological and radiological procedures.
Glucosamine also relieves depression occuring as a result of administration of non-steroidal anti-depressants that are prescribed to individuals suffering from arthritis.
Research on this subject:
Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs Aging. 2007;24(7):573-80.
Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate and collagen hydrolysate. Rheum Dis Clin North Am. 2007;25(2):379-95.
Laverty S, Sandy JD, Celeste C, Vachon P, Marier JF, Plaas AH. Synovial fluid levels and serum pharmacokinetics in a large animal model following treatment with oral glucosamine at clinically relevant doses. Arthritis Rheum. 2005;52(1):181-91.
Rozendaal RM, Koes BW, van Osch GJ, et al. Effect of glucosamine sulfate on hip osteoarthritis: a randomized trial. Ann Int Med. 2008;148(4):268-77.
Vangsness Jr. CT, Spiker W, Erickson J. A review of evidence-based medicine for glucosamine and chondroitin sulfate use in knee arthritis. Arthroscopy. 2009;25(1):86-94.
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Sources and Forms of Glucosamine: |
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Naturally, glucosamine is synthesized in the body from glucose and the amino acid, glutamine. However glucosamine in nutritional supplements is derived from chitin and chitosan, two different forms of glucosamine found in the shells of shrimp, crab, lobster and other similar crustaceans and arthropods. Glucosamine can also be obtained by fermentation of corn and wheat. This vegetable-based glucosamine, also known as synthetic glucosamine, is believed to be superior to shellfish-based glucosamine, as many people suffer from shellfish allergies.
Commercially, glucosamine is available in three forms - glucosamine sulfate, glucosamine hydrochloride, and N-acetylglucosamine. Most of the studies benefits of glucosamine have been done using glucosamine sulfate. However, the other two forms of glucosamine are equally medicinally beneficial. The sulfate and hydrochloride act as carriers and stabilizers of glucosamine, as glucosamine on its own is unstable and can break down. However, some supplements of glucosamine sulfate and glucosamine hydrochloride are marketed as salts (NaCl and KCl). Such supplements should be avoided since the carrier salt may be harmful for those with hypertension and high blood pressure.
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Recommended Dosage of Glucosamine: |
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Based on the clinical studies referenced, the most effective and recommended dosage of glucosamine for joint health is reported at 1500 mg - 2000 mg per day. Higher doses of glucosamine has been shown to have side effects.
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Safety and Side Effects of Glucosamine: |
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Glucosamine, a native substance in the human body, is generally well-tolerated. Glucosamine is synthesized in the body from glucose and glutamine. There are usually no severe adverse side effects from glucosamine administration.
However, an excess of glucosamine can be harmful. Prolonged usage of glucosamine can lead to headaches, insomnia and drowsiness. There may also be temporary digestive problems leading to constipation, heartburn, abdominal pain, and nausea. Glucosamine supplements made from shellfish might be the cause of certain allergic reactions. Since glucosamine is a complex sugar, diabetics should be extra-vigilant while taking glucosamine supplements. Glucosamine also causes increased bleeding and hence individuals taking anti-clotting/blood-thinning agents should take glucosamine only under medical supervision. The safety of glucosamine supplements in children and pregnant and lactating women is not known yet.
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Frequently Asked Questions on Glucosamine: |
Do I need glucosamine supplements?
Glucosamine is synthesized in the body from the raw materials glucose and glutamine - that are naturally available from our food. However, with age, the production of glucosamine slows down and the body's rate of production is exceeded by its rate of glucosamine degradation. Glucosamine is an important factor in keeping the joints healthy and bouncy. It makes movement of the joint smoother and also protects it from regular wear and tear. Hence, after a particular age, glucosamine supplements are recommended (but only after consulting your physician) to keep the joints healthy and strong, and to prevent the onset of joint diseases like arthritis.
Research on this subject:
Dahmer S, Schiller RM. Glucosamine. Am Fam Physician. 2008;78(4):471-6.
National Center for Complimentary and Alternative Medicine. The NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). J Pain Palliat Care Pharmacother. 2008;22(1):39-43.
Can glucosamine be taken by diabetics?
Glucosamine, in basic form, is a complex sugar. Hence, diabetics should take the utmost care when supplementing with glucosamine. Studies show that igh doses of glucosamine can increase blood sugar levels. Other studies, like the 2003 Scroggie et al study, has shown that administration of glucosamine to a sample of Type-2 diabetics had no effect on their blood glucose metabolism.
Research on this subject:
The Arthritis and Glucosamine Information Center.
Scroggie DA, Albright A, Harris MD. The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Arch Inter Med. 2003;163(13):1587-90.
Which form of glucosamine supplement is best for me? Which form should I be wary of?
Glucosamine sulfate and hydrochloride seem to have the same medicinal effects. Since glucosamine alone is extremely unstable, it must be "carried" in stabilizing carrier molecules like sulfate and hydrochloride. Since the principal bioactive molecule is glucosamine, both forms are equally effective. Both forms have also been found to be well-absorbed and well-tolerated by the body. However, some reports show that the hydrochloride form of glucosamine is more effective since it is not effected by the acidic pH in the stomach. More research is needed on this subject before conclusions can be formally drawn. Experts recommend the sulfate form of glucosamine, as it is the more comprehensively studied form of glucosamine supplement.
For those allergic to shellfish, the glucosamine derived from vegetable sources like corn and wheat are recommended.
Some glucosamine supplements in the market have salts added as carriers, in addition to the sulfate or hydrochloride. In such cases, salt can form up to 30% of the weight of the supplement. Manufacturers use salts like NaCl and KCl as a cheaper alternative to other carriers of glucosamine. Salt-based glucosamine supplements should be avoided since excess salt can lead to hypertension and high blood pressure.
Glucosamine sulfate is derived from glucosamine hydrochloride. Since some glucosamine would be lost in this conversion process, glucosamine sulfate would have less bio-available glucosamine than the hydrochloride form. This may be the reason why the sulfate form is costlier than the hydrochloride form.
Research on this subject:
Bucci, L.R. (1995). Nutrition applied to rehabilitation in sports medicine. CRC Press.
Gregory PJ, Sperry M, Wilson AF. Dietary supplements for osteoarthritis. Am Fam Physician. 2008;77(2):177-84.
Murray MT. Glucosamine sulfate: effective osteoarthritis treatment. Am J Nat Med. 1994;1(1):10-14.
Theodosakis, A. and Fox. (1997). The Arthritis Cure. New York:St. Martin's Press.
Is glucosamine an effective treatment for arthritis? Can it cure arthritis completely?
Glucosamine as a possible treatment for arthritis has been heavily studied. Studies have centered around the effect of glucosamine supplementation in individuals suffering from rheumatoid arthritis, osteoarthritis and knee arthritis. Rheumatoid arthritis has many different causes, and glucosamine has been most effective in treating rheumatoid arthritis caused by damaged and/or degraded joint cartilage. Similarly, glucosamine supplements can also treat back pain caused by cartilage degeneration. It is currently well established that glucosamine can treat osteoarthritis and knee arthritis with more efficacy at a lower dosage than conventional arthritic drugs. However, in cases where the joint cartilage is completely lost, glucosamine has little effect.
Research on this subject:
Arthritis Foundation
Glucosamine and Arthritis Information Center
Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT)
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Additional Research on Glucosamine: |
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Glucosamine and Diabetes
Albert SG, Oiknine RF, Parseghian S, et al. The effect of glucosamine on Serum HDL cholesterol and apolipprotein AI levels in people with diabetes. Diabetes Care. 2007 Nov;30(11):2800-3.
Cortinovis M, Cattaneo D, Perico N, Remuzzi G. Investigational drugs for diabetic nephropathy. Expert Opin Investig Drugs. 2008 Oct;17(10):1487-500.
Heerspink HL, Green T, Lewis JB, et al. Effects of sulodexide in patients with type 2 diabetes and persistent albuminuria. Nephrol Dial Transplant. 2008 Jun;23(6):1946-54.
Weiss R, Niecestro R, Raz I. The role of sulodexide in the treatment of diabetic nephropathy. Drugs. 2007;67(18):2681-96.
Wu G, Meininger CJ. Nitric oxide and vascular insulin resistance. Biofactors. 2009;35(1):21-7.
Glucosamine and Arthritis
Callaghan M, Pye S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1. The effects of glucosamine on osteoarthritis of the knee joint. Emerg Med J. 2008 May;25(5):285-7.
Fox BA, Stephens MM. Glucosamine/chondroitin/primorine combination therapy for osteoarthritis. Drugs Today (Barc). 2009 Jan;45(1):21-31.
Frestedt JL, Walsh M, Kuskowski MA, Zenk JL. A natural mineral supplement provides relief from knee osteoarthritis symptoms: a randomized controlled pilot trial. Nutr J. 2008 Feb 17;7:9.
Matsuno H, Nakamura H, Katayama K, et al. Effects of an oral administratino of glucosamine-chondroitin-quercetin glucoside on the synovial fluid properties in patients with osteoarthritis and rheumatoid arthritis. Biosci Biotehnol Biochem. 2009 Feb;73(2):288-92.
Rozendaal RM, Koes BW, van Osch GJ, et al. Effect of glucosamin sulfate on hip osteoarthritis: a randomized trial. Ann Intern Med. 2008 Feb 19;148(4):268-77.
Sanfelix-Gimeno G, Reig-Molia B, Sanfelix-Genoves J, Giner-Ruiz V. Effectiveness of drugs used in degenerative joint diseases. Med Clin (Barc). 2008 Apr 5;130(12):463-5.
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