For those of us who regularly train joint pain at some point in life is almost a certainty. To alleviate this pain many people will look to pain killers such as ibuprofen but as I’ve written about in the past this is probably not the best choice. There are far too many negatives associated with frequent use of NSAID’s for them to be worth using in my opinion. So, with that I think it’s time to take a look at another supplement on the market which may be less abrasive that could potentially help.
What we will be looking at today is glucosamine and chondroitin. The two are separate compounds but are often taken together and even sold together to help with joint pain and to treat osteoarthritis. Glucosamine is a compound made naturally in humans and is involved in the creation of molecules that form cartilage. Chondroitin is a structural component of cartilage.
The Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) (1) was a highly anticipated and government-funded trial in which 1583 patients with symptomatic knee osteoarthritis received either 1500 mg of glucosamine hydrochloride daily, 1200 mg of chondroitin sulfate daily, both glucosamine and chondroitin, 200 mg of celecoxib daily or a placebo for 24 weeks.
Unfortunately the results were a bit tough to make any real conclusions from. 64% of those who took glucosamine, 65% who took chondroitin and 67% who took glucosamine and chondroitin had a reduction in pain. Sounds great right? It does, until we look at the placebo group which had a 60% reduction in pain. The placebo effect has its name for a reason right? Despite 67% of people experiencing reduced pain it was deemed ineffective because of the unusually large placebo rate. Treatments had to be 15% higher than placebo to be effective, and glucosamine and chondroitin was only 7% higher than placebo.
There were also sub groups divided into mild knee pain and moderate to severe pain, but of the 1583 patients only 72 people fell into the sub group of moderate to severe knee pain. In the small sampling size there was a greater success rate of pain relief though. In that group 79.2% of people had reduced pain while 54.3% had reduced pain in the placebo group. Through it all researchers concluded that glucosamine and chondroitin alone or in combination did not reduce pain effectively except in that small sub group.
As a follow-up to this study, 572 of the same subjects went on for another 18 months to make 2 total years in a double-blind placebo-controlled study. (2) Researchers were hoping after a longer period of time they may see some slowing of degeneration of the joint. After 2 years reported, none of the treatment groups showed a significant slowing of the narrowing of the joint meaning there was no slowing of degeneration.
Along the same lines an analysis of 10 studies compromising 3803 people supports the negative findings of the GAIT study. (3) They found in shifting through the research that glucosamine, chondroitin or the combination of the two are no better than placebo for joint pain or narrowing.
Before you completely write off glucosamine and chondroitin, however, there is some interesting research out there that does support it. One knock some have on the GAIT studies as well as others, besides the high rate of placebo, is that they used glucosamine hydrochloride instead of glucosamine sulfate. Most of the studies that showed positive results involved glucosamine sulfate.
For instance research by Herrero-Beaumont et al. (4) looked at glucosamine sulfate in a randomized, double-blind study over a 6 month period in 318 subjects. Subjects received either 1500 mg of glucosamine sulfate, 3 gm of acetaminophen or a placebo daily. They used the Lequesne index (a survey given to patients with osteoarthritis of the knee using a scale system for pain, lower scores mean less pain and higher scores mean more pain) to assess changes over the 6 month period. The results showed a decrease in 3.1 points in the glucosamine group versus 1.9 points with placebo. The 3.1 point drop was slightly higher than the acetaminophen group which saw a 2.8 point drop.
In a much longer-term study (5) that lasted 3 years, researchers gave 202 subjects with mild to moderate osteoarthritis either 1500 mg daily of glucosamine sulfate or a placebo. Results showed the longer treatment slowed the progression of osteoarthritis compared to placebo. Not only did subjects experience a significant reduction in pain and stiffness but on x-ray there was no average change or narrowing of spaces in the joint in the knees in the glucosamine group whereas the placebo group had narrowing over the three years. This would suggest glucosamine sulfate helped keep the knee from deteriorating.
With most supplements when you dig into the research there is a pretty clear determination, but with glucosamine and chondroitin the research is pretty split. There appears to be a high rate of placebo effect with it as well which can make understanding if it works or not more difficult. All research showed them to be safe, so if you have joint pain it may be worth a shot. I would suggest one that uses glucosamine sulfate over glucosamine hydrochloride due to the effectiveness from the research available.
It also appears like glucosamine sulfate alone may be enough, but chondroitin won’t hurt to take if you want the combo. Research alone on chondroitin isn’t all that favorable (6) but when taken together with glucosamine has shown a slight boost over one or the other alone, possibly because chondroitin may have a direct effect at curbing the production of osteoprotegerin and receptor activator of nuclear factor-kappa B ligand which glucosamine significantly reduces the resorptive activity of. (7) In other words, chondroitin may help glucosamine be more effective. Of course as with anything you should consult your physician before starting any new supplement.
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