Healthnotes Newswire (January 25, 2001)—Many double-blind trials have consistently shown that glucosamine sulfate (GS) reduces symptoms of osteoarthritis.^{1 2 3 4 5} Nonetheless, conventional medicine has considered GS unproven—in part because none of these trials was long term, and most of them used imperfect scientific methodology.⁶ All that is about to end. Results of a long-term (three-year), double-blind trial employing near-flawless science will appear in this Saturday’s prestigious medical journal the Lancet.⁷

Two hundred-twelve patients with osteoarthritis of the knee were randomly assigned to receive either placebo or 1,500 mg of GS once per day for three years. At the end of the trial, for those who were followed throughout the trial, symptom scores increased by 10% in the placebo group but decreased 24% in those given GS; X-rays of the knees of patients assigned to take placebo continued to show a significant increase in abnormalities, while no deterioration appeared in the average X-ray of the knees of people given GS. All differences in outcome between people given GS and people given placebo were statistically significant.

For conventional medicine, previous skepticism may now be replaced by a new attitude regarding at least GS––but perhaps other dietary supplements as well. A landmark editorial accompanying the new report concludes, “It is time for [medical doctors] to accommodate the possibility that many nutritional products may have valuable therapeutic effects and to regain the credibility of the public at large.”⁸

The Take-Home Message

For arthritis sufferers, there are several take-home messages to be found in the new report. First, GS is safe. Since GS does not cure people with osteoarthritis and they may need to take the supplement for the rest of their lives, the issue of long-term safety is important. The Lancet report is the first to show that GS has essentially no side effects, even after three years of supplementation. Previous worries about the possibility that GS might increase blood sugar levels simply did not occur. Overall, problems were no more common in people given GS than in those given placebo.

The fact that X-rays continued to show deterioration with placebo but not with GS suggests that GS directly affects the structure of joints. Surprisingly, X-ray evidence of damage to the knee joint does not correlate well with pain levels. Nonetheless, the difference in X-ray findings between the GS group and the placebo group strongly suggests that GS is not simply reducing pain, but is somehow preventing further damage.

The fine print of the new report provides a clue that will make life a bit easier for arthritis suffers. The trial protocol directed patients to take all three 500 mg pills of GS one time per day. Most previous trials (and most supplement labels) have instructed people to take one GS pill three times per day. The fact that the new protocol was effective suggests that arthritis patients no longer need to remember to take GS pills on three separate occasions. Doctors know that patients directed to take all pills at one time are more likely to follow through with the recommended therapy. Increased compliance, in turn, should translate into a better therapeutic effect. Pills of any sort cannot do much good if they are never swallowed.

GS May be Your Stomach’s Best Friend

Conventional medicine has no osteoarthritis therapy that maintains joint structure. In fact, the most common treatment––aspirin and related drugs used to reduce pain––have been reported to increase the rate of joint deterioration in arthritis suffers.⁹ But the most common serious side effect from chronic aspirin use is irritation to the stomach, which often turns into gastritis or even ulcers. By significantly reducing pain levels, long-term use of GS is likely to translate into less aspirin use, and with that, less gastritis and fewer ulcers.

Which Glucosamine is the “Best”?

The current trial did not examine the effects of chondroitin sulfate or glucosamine hydrochloride (HCl). Therefore, it sheds no light on whether these related supplements are more or less effective than GS. (Many previous double-blind trials have shown chondroitin sulfate to be effective;^{10 11 12 13 14 15 16 17 18} the evidence in support of glucosamine HCl remains meager.¹⁹)

Which GS supplement is “best”? The authors of the new report say that the GS used in this study was a “prescription drug,” and that their results cannot be generalized to other glucosamine products (or combination formulas), such as those available as dietary supplements. The authors did not mention that the brand they used (manufactured by Rotta Research Group in Italy) is available in the United States as a supplement––not by prescription. The same GS molecule is found in many supplements available from other companies, and all molecules of GS are identical. So why the issue of “my GS versus your GS?” Possibly, the answer lies in the fact that the Rotta Research Group funded this trial, and two of the ten researchers are Rotta employees. Despite the marketing roar that consumers are about to be exposed to, there may be little reason to think one GS supplement is more effective than any other.