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.

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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.

Moving ahead

This morning, at the gym, I felt no pain while on the treadmill, for the full five minutes. I still felt a little discomfort, stiffness, but it did not bother me. It was a short time and I did not want to tempt fate by staying on the treadmill longer, but it felt good.

Earlier I had felt more pain in my right knee than usual. Lately my knees have been sharing their pain with me more while my right hip offers less. I like to think of this as a kind of progress, because I think the overriding hip pain was blocking out the knee pain for so long, and now the hip pain is less, so the knees are coming back.

Tomorrow I have my second appointment with Paul, the physical therapist. I will see what progress I have made and I hope I will remember to ask about the resurgence of knee pain.

Getting the Strength Back

I was sick on my trip. The first three days I was too sick to even think about exercise (although I continued to do my PT* routines). Then I started feeling better and better. I drove home Wednesday, three days ago, and I am now working on getting back where I was. I've been back to the gym three times, twice doing my weight machine routine and once to an aqua class. I have backed off the weights for most machines both times, and even then I felt tired. But I did them! I keep remembering one tip from the Arthritis Foundation: keep on doing the exercises even when you don't feel tip-top. Thing is, we arthritis folks don't tend to feel tip-top a whole lot, or at least I don't. So if I let the little setbacks throw me I'd never get anywhere.

I came home to find my gimp placard in the mail. So I have been enjoying driving up to the front of the gym, not having to hike in from the farther reaches of the parking lot.



* PT: Physical Therapist - see this and this.

Ears and Thighs

I woke yesterday with a cold. I made it to the gym for my regular routine, then off to sewing class, and finally got home to pack for a trip to Las Vegas. I left home at almost 5:30 yesterday afternoon, planning to stop halfway and continue the trip today. I felt so sick I found it hard to pack and get moving.

I did make it to Mojave as planned, and into my favorite Motel 6. The trains here are very loud but it seemed like I only started hearing them this morning, so they did not interrupt my sleep. My sickness and more interrupted my sleep, though.

At one point I blew my nose and felt a sharp pain in my right ear. I hope I have not done anything seriously wrong to that ear. I don't think so. I woke several times feeling hung over, but without having had the benefit of the alcohol.

Then in the middle of the night I awoke with cramps in my inner thighs. You'd think that with the exercises I do specifically for this part of my body that I would avoid these cramps, but no. I managed to ease out of them by breathing deeply and stretching and drinking water. I don't know how the water helps but it seems to. I am hoping that the rest of the drive will not lead to another set of cramps tonight. Also hoping that I won't get sleepy from the decongestant I hope to be taking soon. I need to stay awake at least until I reach Las Vegas!

A Chatty Morning

I went to the gym to do my usual routine this morning. I met someone I know from my sewing class and we chatted a little (I hate it when people sit on machines and chat with others, and yet I did that!).

Then somebody near me remarked on my Brianhead T-shirt. She asked if I skied. I said no, I went to Brianhead in the summer and yes, it is really beautiful. We talked some about Utah. We both love it and would like to live there except for the provincial nature of many of the residents. Somehow we got to discussing the gym.

She told me I'm really making progress.

I said, "How do you know?"

"I've been watching you since you first started coming here!"

I told her it was hard for me to see any progress, frankly, and that I just keep going. She said she notices it, she can tell the difference. She was not specific but I'll believe her. Why not? I told her I am in pain most of the time and she said she can see that, but that I seem "more alive". Well, I'll take that, whatever that means. We talked of arthritis and pain killers and physical therapy a bit, both said we don't really want to talk about it(!) and finally parted ways.

As I continued my workout, doing my resistance band exercises, I thought about how I am in general. It is hard to see progress when it is so very slow and not always forward-moving. Yet there are small changes I do notice:

* Overall I feel like I am in less pain. It takes less time to reach some comfort level each day.
* I have fewer and shorter instances of hip pain.
* As I've mentioned here before, I have very little shoulder pain now. No pain when I fasten a bra behind my back, for example, and no pain dropping a package in the mailbox from my car.
* When I do my resistance band exercises I do not feel pain in my legs. When I first started doing these one of the hardest parts for me was that standing at the railing simply hurt. It hurts very little or not at all now.

I have even thought about the Active classes. I want so much to be able to do that class without pain. I don't think I am quite there yet but I see light at the end of that tunnel.  I think I am actually achieving something.

Five Gyms on Vacation

My last trip was to Las Vegas and to Acapulco. I spent a few days in Las Vegas on either side of my four days in Acapulco.  During this vacation I went to the gym almost every day. But what gym?? Five different ones.

I was glad that I had talked to Clara about these trips. I brought along my resistance bands, which as it happens I used only a couple of times.  I also knew I could do the five basic physical-therapist exercises on my bed, morning and evening.  Apart from that, I had to adjust to whatever was available. Among the options were, for example:

* The cardio movie room in Henderson, Nevada. The Gold's Gym there has a room that is dark and contains a full-size movie screen. Instead of seats it has cardio machines. Mary and I chose bikes and treadmills and watched part of The Bourne Supremacy, as I recall.  Lots of car chases and people speaking Russian in hurried whispers. Actually filmed in Moscow. It was funny to try to set the machine variables in the dark (people use their cell phones for the light).

* Another Gold's Gym in Las Vegas, very nice, equipped with railings where I could use the resistance bands (the cardio gym didn't have the railings), lots of cool up-to-date equipment. None of the equipment in any of the gyms was like equipment in other gyms, so I was constantly hunting down leg presses, leg extensions, row machines and so on.

* Aqua aerobics at Las Vegas Athletic Club. There is a special separated pool, next to the lap pools, where the aqua classes are held. The water is the same level the whole distance, and it was about four feet, maybe a little more. For me, it was not high enough. The class was led by someone who was clearly not a regular group trainer, but instead appeared to be someone like the rest of us who went through specific training for this class. In a way, it's a nice way to go because a class member is not going to be intimidated by someone who looks like she or he does. I could see that she was following the basic rules - so much time for aerobic, so much time for weight training, and so forth, but she didn't have enough experience to move from one thing to another quickly. Thus, "What shall we do now?" Also, she did not emphasize form as much as I would have liked. Still, I got it done, it was worth the time, it helped me.

* Machines in the gym at a hotel in Acapulco. We stayed at the Las Brisas hotel, which is a fifties-era resort hotel built up a hillside. A lovely place. We had a casita high up the hill and had to call for a ride (in a pink and white jeep) every time we wanted to go somewhere in the hotel (except when Mary walked or ran and sometimes dragged me along). The gym is in a separate building overlooking the bay and has a few bikes, treadmills, a couple of universal type machines, and some other odd massage like tables. I did the bike and figured out some ways to do some of the other exercises on the universal machines. Not a complete workout but not bad, considering I also walked and swam most days.

* Weight room at the Henderson Multigenerational Center. Great place. It has two pools (one olympic-sized, used that day for water polo competition), a water park, an indoor running track, several classrooms, and more. I am able to get most of my routine done in the weight room, with the bikes and machines.  Sometimes when i visit my daughter and grandson come too and we all use the indoor pool.

It was an adventure just working out how to get into these gyms. I think the most reliable type when you visit another city is the gym in your hotel, if there is one. Otherwise, I'd be using the resistance bands and trying to find a good way to get some cardio in. I'm lucky in Las Vegas because my daughters live there so I can find ways to get in, at least once, to some gyms.  If I were able to walk more consistently there would be many more options available. For now, I am grateful for what there is.