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Thursday, September 30, 2010

Glucosamine and Chondroitin are no help

From McDougall's newsletter Sept 2010:

Glucosamine and Chondroitin Do Not Help Arthritis
Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis by Simon Wandel, published in the September 22, 2010 issue of the British Medical Journal concluded, “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.”1 They went on to say, “Our network meta-analysis of all 10 available large scale patient blind randomised trials in 3803 patients with knee or hip osteoarthritis showed no clinically relevant effect of chondroitin, glucosamine, or their combination on perceived joint pain.”
Comment: The most common form of arthritis afflicting humans is osteoarthritis, often referred to as degenerative arthritis, because the joints slowly deteriorate as a result of “normal wear and tear associated with aging.” Doctors commonly advise people to lose weight, especially if they have disease of the joints of the lower extremities, and to avoid prolonged and strenuous use of the affected joints. Non-steroidal anti-inflammatory drugs (NSAIDs), such as Motrin and Advil, are commonly taken for pain relief. Paradoxically, these NSAIDs also accelerate the loss of cartilage in the joints and delay bone healing.2,3 This then worsens the osteoarthritis.
Taking cartilage constituents, such as glucosamine and chondroitin, has been recommended for osteoarthritis, and many studies support its use. In my April 2004 newsletter I recommended glucosamine for arthritis based on the research I had available then. However, in the past six years I can recall no patients telling me of pain relief or improved mobility that they have achieved from taking this cartilage supplement. Therefore, I am changing my recommendation. Because of the low cost and few side effects, you may still wish to do your own personal trial with glucosamine, but I can no longer tell you that I believe it is beneficial. (I reserve the right to change my opinions on all medications and supplements because the research is always changing and most of it cannot be trusted as reliable in the first place. In case you are wondering, I will not be changing my opinion on the best diet for you.) I have never recommended chondroitin because it is derived from cow cartilage. This cow matter may contain infectious microbes, such as those that have been found to cause mad cow disease.4
The overall benefits of a healthier diet and weight loss for osteoarthritis are well established.5 Three-hundred and sixteen older, overweight or obese, sedentary men and women with x-ray evidence of knee osteoarthritis were randomly assigned to one of four 18-month treatments: healthy lifestyle control, diet-induced weight loss, exercise, and diet plus exercise. Those who lost weight due to an improved diet showed a decrease in inflammation measured by a variety of tests. Exercise did not seem to make a positive difference in this study.
I recommend people with osteoarthritis take very good care of their diseased joints. This means in many cases that they should avoid certain exercise. Someone with disease of their hips, knees, or ankles should not be running, and maybe should limit their walking. Instead, exercise for them should be bicycling, swimming, and/or rowing. The best diet for weight loss and overall joint health is the McDougall diet.
1) Wandel S, J¸ni P, Tendal B, N¸esch E, Villiger PM, Welton NJ, Reichenbach S, Trelle S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis.BMJ. 2010 Sep 16;341:c4675. doi: 10.1136/bmj.c4675.
2) Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol. 2008 Jan;102(1):10-4.
3) Ding C, Cicuttini F, Jones G. Do NSAIDs affect longitudinal changes in knee cartilage volume and knee cartilage defects in older adults? Am J Med. 2009 Sep;122(9):836-42.
4) Mad cow disease and chondroitin sulfate. Harv Health Lett. 2001 May;26(7):3.
5) Nicklas BJ. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Am J Clin Nutr. 2004 Apr;79(4):544-51.
The comments above are by Dr. McDougall. I notice that in his recommendations he says "exercise did not seem to have a positive effect in this study". Meaning exercise alone did not reduce pain. 

He goes on to recommend for and against certain types of exercise - swim, don't walk, for example. Take care of your joints.  And eat a low-fat vegan diet. I already eat a whole-foods vegan diet so do not believe that the inflammation in my joints comes from my food (I have done some limited tests). I do tend to stray from low-fat from time to time, sorry to say.

I think certain types of exercise can in fact reduce pain. But the exercises do need to be specific to the source of pain, which is the type that I am doing now. I have noticed some differences in the pain - both in the intensity and the length of time I am in pain, and I hope to find some specific changes when I go to the physical therapist tomorrow.

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