Should I take Glucosamine and Chondroitin?

No.

Phew, that was a short blog. Time for a cuppa and a biccie I think…

Alas, if only it was that simple…

… I get asked a lot about Glucosamine and Chondroitin (G&C) supplements in my clinic. They are, in theory, the building blocks to cartilage and have been widely recommended to reduce the progression of arthritis and cartilage problems. They are also part of a multimillion pound industry and one that funds much of its own research.

In 2010 the British Medical Journal (one of the most reputable of all scientific publications) published this article by Wandel et al. which reached fairly damning conclusions about the use of G&C. They performed a 'Network Meta-Analysis' of the available evidence (up to June 2009) and reviewed the data from the 10 trials that met their inclusion criteria (i.e. that they found were of suitable quality). These trials included a total of 3803 patients with arthritis of the knee or hip.

Their review examined the effect of G&C supplements (including Glucoasmine, Chondroitin and a combination of the two) on pain and joint space narrowing versus placebo. Pain was measured on a 10 point Visual Analog Scale (VAS – this means they were asked to rate their pain from 0 no pain to 10 worst possible pain and note it on a 10cm scale). Joint space narrowing can be seen on X-ray and occurs as a consequence of arthritic change.

They found that the overal difference in pain intensity compared with placebo (on the 10cm VAS) was -0.4 for Glucosamine, -0.3 for Chondroitin and -0.5 for the combination of both. All except 3 trials were funded by the manufacturers of the supplements. For those that were independent the treatment effect was 'minute to zero and by no means clinically relevant.' The changes in minimal joint space width were also all described as minute leading them to conclude,

“Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.”

Reproduced from Wandel et al. 2010

So is it fair to conclude that it's not worth taking G&C supplements?

Well, sort of.

That's the definitive answer you were after! With any aspect of health care the decision is always that of the individual. I won't say, “take this” or, “don't take that”, instead I present the evidence to people to let them make an informed decision. I have seen patients describe dramatic reductions in pain after taking G&C. If the supplement helps your symptoms it may be worth continuing it, especially if stopping taking it causes an increase in pain. I've also seen many report no change and complain about the ongoing cost. 1 or 2 have reported occasional side effects, although these supplements are generally considered fairly safe to take.

Other studies have shown more promising results, with Bruyere et al. (2008) concluding G&C may reduce the need for total joint replacement. It's worth noting however, that in terms of quality of evidence, a systematic review of multiple research papers is usually considered better evidence than an isolated study. A recent meta-analysis of over 1500 cases by Lee et al 2010 did show that G&C may slow progression of osteoarthritis (as measured by X-ray change) although it required taking it daily over 2-3 years.

Sawitzke et al. 2010 found “no clinically important difference in pain or function” when compared to placebo. The Cochrane Review (2009) – Glucosamine Therapy for Treating Osteoarthritis had somewhat mixed results but concluded it may reduce pain and improve function.

The National Institute of Clinical Excellence (NICE) guidelines are seen by many as a reliable opinion on medical matters. Their guidelines on the management of osteoarthritis stated that,

“The use of glucosamine products is not recommended for the treatment of osteoarthritis.”

Prices of G&C vary a great deal, currently Boots Pharmacy has a 2 month supply at £30, meaning a 2-3 year course would be £360-540. If you chose to use just Glucosamine (without chondroitin) a 6 month supply is £30 meaning £120-180. So the question you need to ask yourself is, am I willing to spend that much on a treatment that might help or may make no difference to my pain or the progression of arthritis?

Words of caution: If you are planning to take supplements to treat arthritis or other conditions discuss this with your GP or Pharmacist.

 

Categories

About the Author:

4 Comments
  1. I started taking glucosamine + collagen daily about three years ago when I was having back problems. After about 6 months or so I noticed a positive difference in my skin, which seems much more pliable and less prone to dryness than it’s ever been. I fixed the back problem with exercise and massage, so I’ve no idea whether the glucosamine makes a difference to other connective tissues, but I reckon it’s a small price to pay for something that might just help protect your joints.

  2. You could of course just eat a lot healthier.. Eat chicken thighs & legs instead of the breast.. Enjoy delicious home made soups recipes with real stock bases made from bones & Cartilage (like our grandparents used too)
    Maybe eat some more beef, chicken, fish, eggs, dairy products, cabbage, beets, beans, spinach, and parsley – they’re def gonna help.
    & maybe try to get off the over abuse of the NSAID’s if you can..
    Not trying to get into the debate about whether supplements work or not, as I’m sure sometimes they do.. Just that mother nature provides in a much more digestible form if we know where to look for it – Taste’s a darn sight nicer too!!
    Just my view.

  3. Conor Bourke

    I found it helped me with shoulder wear & tear after years of rugby. Combinatin of glucosamine 1500mg condroitin 1200mg and MSM 250mg. Have stopped it about 8 months ago just by falling out of habit of taking it after dinner. Haven’t noticed any worsening as yet. Dosage has to be over 1000mg’s per day I was advised, and was also advised to take a month on month off approach also once under control.

  4. EBM Fan

    I have to say I think your conclusion is wrong, though a different reading of the evidence.

    The one thing in common with all the positive studies (Bruyere for example), is that they use the glucosamine sulphate formulation. The so-so and negative studies all use glucosamine hydrochloride. These have different bioavailabiliy, and clearly different efficacy. The meta-analysis is well conducted, and has all the studies. Without methodologicaly flaws in any of them, the whole evidence is much more useful. Look at Figure 3. On the bottom of the blobbogram, is a statistically significant benefit for glucosamine sulphate, with chloride being equivalent to placebo. The partial efficacy then all makes sense – you have an inert and a good form mixed together, with equivcal results. Split it by the right metrics and you can see a clear benefit.

    Given a number of studies with identical results, with the somewhat shaky endpoint of joint space narrowing, it is fairly convincing, but add in the 5 year follow up with a real reduction in joint replacement, and I’m convinced.

    Next tip would be Poundland and 99p stores sell glucosamine sulphate. They are extremely safe, so at worst you are getting no effect, or a placebo effect. Do note however that the studies use a dose of 1500mg of sulphate per day, that is the same as FOUR tablets that you normally get, not one. Without the dose studied, you are unlikely to see any effect. Anyway with 30 tablets per bottle, that’s 3.3p per tablet. at £0.13 per day, I think it is a good bet. There is certainly more evidence for it than most things we (runners) do!

    Interesting to hear your take, and feel free to get in touch if you want to discuss more. Anyway keep up the good work!

2 Pings & Trackbacks
  1. [...] question gets asked at lot. Click the post and read here to find out [...]

  2. […] Running Physio: Should I take Glucosamine and Chondroitin […]

Leave a Reply


two + 7 =

Follow

Get every new post delivered to your Inbox

Join other followers:

%d bloggers like this: