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Table of Contents > Supplements > Glucosamine
Glucosamine
Also Known As:  glucosamine sulfate, glucosamine hydrochloride, N-acetyl glucosamine
 
Overview
Uses
Dietary Sources
Available Forms
How to Take It
Precautions
Possible Interactions
Supporting Research

Overview

Glucosamine, which occurs naturally in the body, plays a key role in the construction of cartilage -- the tough connective tissue that cushions the joints. Glucosamine stimulates the production of glycosaminoglycans (the key structural components of cartilage) as well as the incorporation of sulfur into cartilage. Sulfur is necessary for making and repairing cartilage.

Glucosamine may be effective in treating and possibly slowing the progression of osteoarthritis. This is a type of arthritis caused by continuous wear and tear on the joints leading to inflammation, breakdown, and eventual loss of cartilage. The tissues most affected by osteoarthritis are the weight bearing joints, such as the knees and hips, as well as the joints in the hands.

Studies suggest that glucosamine may be at least as effective as some of the medications frequently used to treat this joint condition, but with fewer gastrointestinal side effects. The medications used to treat osteoarthritis are known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and piroxicam. NSAIDs may cause stomach upset, cramps, constipation, diarrhea, and in some cases, stomach ulcers.

Glucosamine is often taken with chondroitin, another supplement thought to be effective in treating arthritis. These substances are often combined with manganese as well, a trace metal that is also needed for building cartilage.


Uses

Arthritis
Although not every single study agrees, strong evidence from many well-designed trials, indicate that glucosamine sulfate supplements may be an effective treatment for osteoarthritis -- particularly osteoarthritis of the knee. In general, findings from these studies suggest that glucosamine provides several benefits for people with osteoarthritis including pain reduction (as effective as ibuprofen and other NSAIDs), improved function and mobility, and slowed progression or even prevention of joint destruction when taken for 3 or more years.

In comparison to NSAIDs, glucosamine takes longer to begin working. However, pain control lasts longer with glucosamine and the supplements cause fewer side effects.

Although glucosamine and chondroitin are often administered together for the treatment of osteoarthritis, it is not clear that the combination works better than either supplement alone. Nor is it clear if glucosamine is better than chondroitin or vice versa. Perhaps the most definitive results regarding the effectiveness of glucosamine and chondroitin for osteoarthritis will be achieved with the ongoing Glucosamine/Chondroitin Arthritis Intervention Trial sponsored by the National Institutes of Health. This large-scale study involving over 1,600 people is investigating the effects of glucosamine alone, chondroitin alone, and a combination of both for the treatment of knee osteoarthritis. Results are expected in 2005.

Inflammatory Bowel Disease (IBD)
Crohn's disease and ulcerative colitis are two inflammatory bowel diseases that are marked by chronic, recurrent bloody diarrhea. Preliminary evidence suggests that N-acetyl glucosamine oral supplements or enemas may improve symptoms of IBD in children who do not improve from standard medical treatments. Further research is needed, however, to determine whether the substance is safe and effective for the treatment of IBD.


Dietary Sources

There are no food sources of glucosamine. Supplements are derived from either bovine cartilage or chitin, the hard outer shells of shrimp, lobsters, and crabs.


Available Forms

Glucosamine is available as an oral supplement in the following forms:

  • Glucosamine sulfate: 500, 750, and 1,000 mg capsules and tablets
  • N-acetyl glucosamine: 500 and 750 mg capsules and tablets
  • Glucosamine hydrochloride (HCL): 500, 750, and 1,000 mg capsules and tablets
  • Glucosamine/chondroitin sulfate combination products (often contain manganese as well)

Glucosamine sulfate is the form used in most research studies. It is believed to be the best source because it provides the sulfur necessary for making and repairing cartilage.

Glucosamine is also available as an injectable form that your physician can insert directly into the arthritic joint. N-acetyl glucosamine is also available as an enema.


How to Take It

Pediatric

There are no known scientific reports on the pediatric use of glucosamine. Therefore, it is not currently recommended for children.

Adult

  • 1,500 mg per day (500 mg three times a day) for one to two months

Ongoing supplementation (roughly 1,000 mg per day) may be required to prevent the progression of osteoarthritis or to reduce pain and inflammation associated with the condition.


Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

The majority of studies indicate that glucosamine is safe, nontoxic, and causes only minor side effects such as stomach upset, heartburn, indigestion, gas, bloating, and diarrhea. If these symptoms occur, glucosamine should be taken with food.

People with peptic ulcers should take glucosamine sulfate with food.

Glucosamine sulfate may contain high amounts of sodium or potassium, so individuals on a restricted diet or taking potassium-sparing diuretics should carefully check the label before taking glucosamine supplements.

People with diabetes should have their blood sugar checked regularly as glucosamine may cause insulin to work less effectively. Some glucosamine supplements are derived from shellfish, so individuals with shellfish allergies should check with a health care professional before taking these supplements.

People who are allergic to sulfur are usually allergic to sulfa drugs or sulfite-containing food additives. Sulfur is an essential nutrient that is naturally present in the body of all individuals. "Sulfur-sensitive" people can safely use glucosamine sulfate.


Possible Interactions

If you are currently being treated with any of the following medications, you should not use glucosamine or make any adjustments to your medications without first talking to your healthcare provider.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Glucosamine may increase the anti-inflammatory activity of NSAIDs such as ibuprofen. This interaction may result in the need for lower doses of these medications.


Supporting Research

Adams ME. Hype about glucosamine [editorial]. Lancet. 1999;354:353-354.

Chard J. Glucosamine for osteoarthritis: magic, hype, or confusion? It's probably safe-but there's no good evidence that it works [editorial]. BMJ. 2001;322:1439-1440.

da Camara CC, Dowless GV. Glucosamine sulfate for osteoarthritis. Ann Pharmacother. 1998;32:580-587.

Das A, Hammond TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage. 2000;8(5):343-350.

Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999;25:379-395.

Delafuente JC. Glucosamine in the treatment of osteoarthritis. Rheum Dis Clin North Am. 2000;26(1):1-11.

Gaby AR. Natural treatments for osteoarthritis. Altern Med Rev. 1999;4(5):330-341.

Gottlieb MS. Conservative management of spinal osteoarthritis with glucosamine sulfate and chiropractic treatment. J Manipulative Physiol Ther. 1997;20(6):400-414.

Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Alt Med Rev. 1998;3(1):27-39.

Leeb BF, Schweitzer H, Montaq K, Smolen JS. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000;27:205-211.

Leffler CT, Philippe AF, Leffer SG, Mosure JC, Kim PD. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med. 1999;164:85-91.

McAlindon T. Glusoamine for osteoarthritis: dawn of a new era? Lancet. 2001;357(9252):247-248.

McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis.
JAMA. 2000;283(11):1469-75.

McCarty MF. Enhanced synovial production of hyaluronic acid may explain rapid clinical response to high-dose glucosamine osteoarthritis. Med Hypothes. 1998;50:507-510.

Murray MT, Pizzorno JE. Glucosamine. In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. Vol 1. 2nd ed. Edinburgh: Churchill Livingstone; 1999:761-765.

National Institutes of Health. Glucosamine/Chondroitin Arthritis Intervention Trial Begins Patient Recruitment. Bethesda, Md: National Institutes of Health, National Center for Complementary and Alternative medicine; December 11, 2000. NIH News Release.

Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001;357:251-256.

Rindone JP. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. West J Med. 2000;172(2):91-94.

Salvatore S, Heuschkel R, Tomlin S, et al. A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosaminoglycan synthesis, in pediatric chronic inflammatory bowel disease. Aliment Pharmacol Ther. 2000;14:1567-1579.

Shankar RR, Zhu JS, Baron AD. Glucosamine infusion in rats mimics the beta-cell dysfunction of non-insulin-dependent diabetes mellitus. Metabolism. 1998;47:573-577.

Special Report: A look at glucosamine and chondroitin for easing arthritis pain. Tufts University Health & Nutrition Letter. January 2000;17(11):4-5.

Thie NM, Prasad NG, Major PW. Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temperomandibular joint osteoarthritis: a randomized double blind controlled 3 month clinical trial. J Rheumatol. 2001;28:1347-1355.

Towheed TE, Anastassiades TP. Glucosamine and chondroitin for treating symptoms of osteoarthritis. JAMA. 2000;283(11):1483-1484.

Zupanets IA, Drogovoz SM, Bezdetko NV, Rechkiman IE, Semenov AN. The influence of glucosamine on the antiexudative effect of nonsteroidal anti-inflammatory agents [in Russian]. Farmakol Toksikol. 1991;54(2)61-63.


Review Date: April 2002
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, Ma; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH; Margie Ullmann-Weil, MS, RD, specializing in combination of complementary and traditional nutritional therapy, Boston, MA. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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