Glucosamine Review

By G. Douglas Andersen, DC, DACBSP, CCN

In the summer of 1993 I was accumulating literature and preparing a three part series on glucosamine when I got scooped by my own publication. The September 12, 1993, issue of Dynamic Chiropractic contains an excellent article by Michael Murray, ND, on the treatment of osteoarthritis with glucosamine. 
I urge any readers who want in-depth information on glucosamine (definitions, biochemical action, and references) to read this article.

In the last few years, interest in glucosamine has been on the rise. The majority of positive studies occurred in the late 1970s and early 1980s and were published outside the U.S. Maybe that's why it took almost a decade to catch on in America. These foreign studies show that ingestion of the sulfate form of glucosamine: 

1. is well-absorbed when taken by mouth;
   
   
2. stimulates the synthesis and repair of connective tissue and cartilage;
   
   
3. blocks the breakdown of cartilage;
   
   
4. relieves joint pain and inflammation;
   
   
5. increases range of motion;
   
   
6. continues to suppress symptoms weeks after administration is discontinued;
   
   
7. does not have side effects (a refreshing alternative to the abdominal pain, dyspepsia, diarrhea, and peptic ulcers caused by nonsteroidal anti-inflammatories);
   
   
8. is dosed at 500 mg three times per day for eight weeks, away from food (occasionally patients may have gastrointestinal complaints; in the event this occurs, try dosing with meals);
   
   
9. takes two to six weeks for patients to "feel the effects";
   
   
10. the only anatomic regions specifically mentioned in studies were the knee and hip. I did not see any studies that were limited to arthritis of the spine.

All the studies with glucosamine utilized the sulfate form. Glucosamine hydrochloride and N acetyl glucosamine are also on the market. Companies selling these forms make good arguments that they work. However, there have been no human studies with arthritic patients -- positive or negative -- utilizing these forms of glucosamine. The hydrochloride and N acetyl forms are less expensive than the sulfate variety. If you decide to try one of these untested forms, I would appreciate any feedback, good or bad. There have also not been any studies on glucosamine for conditions such as whiplash, sprains, and disc problems. However, a substance that can stimulate proteoglycan and glycosaminoglycan production should be considered for any serious musculoskeletal problem.

After discontinuing oral glucosamine sulfate therapy, symptoms did eventually return in patients with osteoarthritis. In my personal practice, after eight weeks of 1500 mg of glucosamine sulfate a day (10 mg per pound for larger and obese individuals), I have not been discontinuing therapy, but instead reducing doses to 500 mg per day. When initiating glucosamine therapy, patients should be informed that glucosamine treats a cause rather than a symptom and therefore, they will not have the immediate reduction in pain that nonsteroidal anti-inflammatories produce. I show my patients summaries of studies where arthritic people who take glucosamine sulfate orally eventually feel better than those on anti-inflammatory medication. In my practice, I have observed favorable results with glucosamine therapy.