Chondroitin Sulfate and Glucosamine

Chondroitin Sulfate: Glucosamine’s Perfect Partner?
by Jennifer Hornsby

In addition to glucosamine sulfate, Dr. Theodosakis and others recommend taking dietary supplements of chondroitin sulfate. This water-attracting/binding cartilage compound consists mostly of glucosamine sulfate. Controlled clinical studies of oral and injected doses of chondroitin sulfate—five, to date—have produced results that are quite good, but much weaker than those seen with glucosamine sulfate.

Glucosamine and chondroitin sulfate perform complementary functions in cartilage, and some researchers, including Dr Theodosakis, believe that it makes sense to take both. This view is supported by experiments in test tubes and animals that produced results superior to using glucosamine alone. But it does not appear likely that the increased cost of the combination is worth the minor added benefit. There are four reasons most researchers are very skeptical that the combination of glucosamine and chondroitin is better than taking glucosamine alone.

Chondroitin sulfate is considerably more costly, but produces markedlyweaker clinical results than glucosamine sulfate. Chondroitin is a much bigger molecule, which explains why much less is absorbed (0-13%, vs. 90-98% of glucosamine sulfate absorbed). Your body doesn’t need supplemental chondroitin to make more supplemental glucosamine sulfate alone stimulates synthesis of chondroitin by cartilage-building cells.

Finally, chondroitin sulfate has been subjected to far fewer clinical trials, most involving injections, not oral supplements.

Most practitioners recommend taking glucosamine alone for eight weeks, to see if benefit is achieved before adding the expense of supplemental chondroitin sulfate.

References:
1. Bland JH, Cooper SM: Osteoarthritis: . . . evidence for reversibility. Semin Arthr Rheum 1984;14:106-33.
2. Perry GH, Smith MJG and Whiteside CG: Spontaneous recovery of the hip joint space in degenerative hip disease. Ann Rheum Dis 1972;31:440-8.
3. McCarty, F: The neglect of gluscosamine as a treatment for osteoarthritis. Medical Hypotheses, 1994, May;42(5):323-7.
4. Shield MJ: Anti-inflammatory drugs and their effects on cartilage syntheisis and renal function. Eur J Rheum Inflam, 1993;13:7-16.
5. Krajickova J, Macek J. Urinary proteoglycan degradation product excretion in patients with rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 1988 Jun;47(6):468-71.
6. Setnikar, I: Antireactive properties of chondroprotective drugs. Int. J. Tissue React. 1992; 14(5):253-61.
Vidal y Plana, Karzel K: Glucosamine: Its importance for the metabolism of articular cartilage. Fortscher Med. 1980 June, 5;98(21):801-6.
7. Prudden JF, et al. The discovery of a potent pure chemical wound healing accelerator. Am Journal of Surgery 1970;19:560.
8. McCarty, F: The neglect of gluscosamine as a treatment for osteoarthritis. Medical Hypotheses, 1994, May; 42(5):323-7.
9. Mazières B, et al. Chondroitin sulfate in the treatment of gonarthritis and coxarthritis. 5-months result of a multicenter double-blind controlled prospective study using placebo. [French] Rev Rheum Mal Ostéoartic59(7-8):466-472, Jul-Sep 1992.
10. Rovetta, G. Galactosaminogylcuronoglycan sulfate (matrix) in threapy of tibiofibular osteoarthritis of the knee. Drugs in Experimental Clinical Research 18(1):53-57, 1991.
11. Pipitone VR. Chondroprotection with chondroitin sulfate. Drugs in Experimental Clinical Research 17(1):3-7,
1991.
12. Oliviero, U, et al. Effects of the treatment with matrix on elderly people with chronic articular degeneration. Drugs
in Experimental Clinical Research 17(1):45-51, 1991.
13. Kerzberg EM, et al. Combination of glycosaminoglycans and acetylsalicylic acid in knee osteoarthritis.
Scandinavian Journal of Rheumatology 16:377-380,
1987.

Chondroitin Sulfate What does it do?

Chondroitin sulfate consists of repeating chains of molecules called mucopolysaccharides. Chondroitin sulfate is classified as a type of glycosaminoglycan; it is rich in sulfur and is related to glucosamine. Chondroitin sulfate is a major constituent of cartilage, providing structure, holding water and nutrients, and allowing other molecules to move through cartilage—an important property, as there is no blood supply to cartilage.

Chondroitin and similar compounds are present in the lining of blood vessels and the urinary bladder. They help prevent abnormal movement of blood, urine, or components across the barrier of the vessel or bladder wall. Part of chondroitin’s role in blood vessels is to prevent excessive blood clotting. However, it is unclear whether supplements of chondroitin are able to favorably affect blood clotting. In addition, chondroitin sulfate may lower blood cholesterol levels.1 Older preliminary research showed that chondroitin sulfate may prevent atherosclerosis in animals and humans and may also prevent heart attacks in people who already have atherosclerosis.2 3 4

Animal studies indicate that chondroitin sulfate may promote healing of bone, which is consistent with the fact that the majority of glycosaminoglycans found in bone consist of chondroitin sulfate.5 Chondroitin sulfate also appears to help restore joint function in people with osteoarthritis.6 Where is it found? The only significant food source of chondroitin sulfate is animal cartilage. In what conditions might chondroitin sulfate be supportive?

• atherosclerosis
• high cholesterol
• kidney stones
• osteoarthritis

Who is likely to be deficient? Because the body makes
chondroitin, the possibility of a dietary deficiency remains uncertain. Nevertheless, chondroitin sulfate may be reduced in joint cartilage affected by osteoarthritis and possibly other forms of arthritis.

How much should I take? For atherosclerosis, researchers
have used very high amounts, such as 5 grams twice per day with meals, lowering the amount to 500 mg three times per day after a few months. Before taking such high amounts, people should consult a nutritionally oriented doctor. For osteoarthritis, a typical level is 400 mg three times per day. The ability for chondroitin to be absorbed orally is still under question.

Are there any side effects or interactions? Nausea may occur at intakes greater than 10 grams per day. No other adverse effects have been reported. The hypothesis that glucosamine sulfate and chondroitin sulfate work synergistically in the support of osteoarthritis remains unproven. The fact that they are structurally similar suggests that they may act in similar ways.

References:
1. Izuka K, Murata K, Nakazawa K, et al. Effects of
chondroitin sulfates on serum lipids and hexosamines in atherosclerotic patients: With special reference to thrombus formation time. JpnHeart J 1968;9:453-60.
2. Morrison LM, Bajwa GS, Alfin-Slater RB, Ershoff BH.
Prevention of vascular lesions by chondroitin sulfate A in the
coronary artery and aorta of rats induced by a hypervitaminosis D, cholesterol-containing diet. Atherosclerosis 1972;16:105-18.
3. Morrison LM, Branwood AW, Ershoff BH, et al. The
prevention of coronary arteriosclerotic heart disease with chondroitin sulfate A: Preliminary report. Exp Med Surg
1969;27:278-89.
4. Morrison LM, Enrick NL. Coronary heart disease:
Reduction of death rate by chondroitin sulfate A. Angiology
1973;24:269-82.
5. Moss M, Kruger GO, Reynolds DC. The effect of
chondroitin sulfate on bone healing. Oral Surg Oral Med Oral Pathol 1965;20:795-801.
6. Kerzberg EM, Roldan EJA, Castelli G, Huberman ED.
Combination of glycosaminoglycans and acetylsalicylic acid in
knee osteoarthritis. Scand J Rheum 1987;16:377.

Jennifer Hornsby
NorCal Boxer Rescue

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