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TOPIC TITLE: glucosamine and chondroitin sulfate
Created On 2/23/06 6:02 PM
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2/23/06 6:02 PM
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By Gina Kolata The New York Times

Two widely used nutritional supplements for arthritis pain do not effectively soothe patients' aching arthritic knees, a large U.S. government study has found.

The study of the two supplements, glucosamine and chondroitin sulfate, was published Thursday in The New England Journal of Medicine. The study was meant to provide a definitive answer to a question that has baffled doctors and patients alike: Do these supplements work?

Americans spent an estimated $734 million on glucosamine and chondroitin in 2004, according to The Nutrition Business Journal, making them among the most widely used dietary supplements in the nation. The two are often sold in combination as a treatment for arthritis.

In the 24-week study, 1,583 patients with osteoarthritis of the knee were randomly assigned to one of five groups. Some patients took glucosamine, some took chondroitin and some took both. Others, serving as comparison subjects, took a placebo or celecoxib, sold as Celebrex, a prescription drug that is approved for osteoarthritis.

No effect was found for glucosamine, chondroitin or a combination of the two. But the study found that the patients who took celecoxib had a statistically significant improvement in their symptoms.

Although the new study found no overall effect for the supplements, the authors and some other medical researchers said that an analysis of a subgroup of patients provided hope - although not definitive evidence - that the supplements taken together might help some people with severe pain.

"Patients who had more pain did seem to be helped by the combination," said Dr. Daniel Clegg, a researcher at the University of Utah School of Medicine who was the lead author of the study. But he hastened to add that this observation would have to be confirmed in later studies.

Dr. Marc Hochberg, head of the division of rheumatology and clinical immunology at the University of Maryland, said it was possible that another type of glucosamine might be effective.

The study used glucosamine hydrochloride because it was the only type that could be manufactured at the time in a sufficiently pure form.

In Europe, where glucosamine and chondroitin are sold as drugs, glucosamine comes in the form of glucosamine sulfate, Hochberg said, and some industry-supported studies have indicated that this form helps. But others said there was no reason to expect that glucosamine sulfate would be any different from glucosamine hydrochloride.

Because the supplements are so popular, the results of the trial had been eagerly anticipated.

"We've been talking about the importance of this study for the last two or three years," said Dr. John Klippel, president and chief executive of the Arthritis Foundation. "This is the most important study ever done. It has a very large number of patients and it is scientifically rigorous."

Previous studies of glucosamine and chondroitin tended to be small, with no more than 100 or so patients, and they looked at the supplements' effectiveness only over the short term.

Many of the studies had methodological flaws, and their results were contradictory. A handful of publicly financed trials, in the United States, Canada and Britain, showed no effect for the supplements. Other studies, financed by supplement makers, "were impressively positive," Felson said.

Clegg said the new study, financed by the National Center for Complementary and Alternative Medicine and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, arose after an expert panel in 1998 concluded that "there is a real and urgent public health need to test these agents in a rigorous way."

Glucosamine and chondroitin are substances found naturally in joints, leading some to suggest that they might be helpful for arthritis patients. Glucosamine is a modified sugar that is thought to play a role in the formation and repair of cartilage, and chondroitin is part of a large protein, proteoglycan, that provides elasticity to cartilage.

But, arthritis researchers say, they know of no biological reason why eating those compounds would help people with arthritis.

Dr. Tim McAlindon, chief of rheumatology at Tufts-New England Medical Center in Boston, said that glucosamine travels to the liver, which then breaks it down. Almost no glucosamine that is eaten actually gets into the blood, where it can travel to the joints, he said.

Chondroitin, a large molecule, is digested, McAlindon said, but it is broken into pieces in the intestines and none of it gets through intact to the joints.

Still, many arthritis patients swear by the supplements, which cost $30 to $50 a month, said Andrew Shao, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a trade association for the dietary supplement industry.

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11/26/06 4:33 PM
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I have found that capsium pills work very well.


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11/26/06 7:42 PM
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Much of this New York Times article is true. Glucosamine is a neccesary nutrient in the human body. Glucosamine supplements are taken both as a nutritional supplement and as a condition specific supplement. Most glucosamine and chondroitin sulfate supplement are very ineffective. What people should be using to replenish joints and for joint pain is Glucosamine HCl, the most absorable form of glucosamine around. There is a product by Melaleuca, Inc., called Replenex, which is patented and proven to work. There are no known negative side effects. It come with a 90-day empty-bottle money-back guarantee. Don't worry, you won't need to return it.

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Edited: 11/26/06 at 8:00 PM by MOSHEBUNIN

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