by Anthony L. Almada, BSc, MSc
You just ran a 10K, did several sets of leg extensions, or climbed several flights of stairs ... again. And your knees are sore. You've gained a "friend" around your waist or hips and, despite your best intent and recent weeklong Tony Robbins seminar, your knees prevent you from going for power walks or climbing onto a stair climber as frequently as you use your Starbucks debit card. What may be aching you is osteoarthritis (OA). If you're between 35-74 years of age, this most common form of arthritis unites you with between 5-15% of your age-mates in the occidental world. Estimates suggest that 6 out of every 100 persons in the US have the symptoms of OA. Surprisingly, no drug therapies appear to have the ability to slow or even reverse the course of the condition. But if we shift our eyes away from the pharmacist and the prescription pad we see a beacon of promise: glucosamine sulfate.
Glucosamine sulfate may be the best form to use
Hundreds of products on the market contain one or more forms of glucosamine, the top three being glucosamine sulfate (GS), glucosamine hydrochloride (GC), or, rarely, N-acetylglucosamine (NG). However, which form has undergone the most scrutiny in published clinical studies? Which form has actually been shown in most of the published studies to be ineffective? Which form has yet to be "proven effective" in a controlled clinical study published in a medical journal? GS, GC, and NG, respectively. Yes, GS (glucosamine sulfate) wins the prize and GC is the relatively weak fledgling, from the simple perspective of solid evidence. Choosing any other form of glucosamine over GS is like opting for a restaurant that has repeatedly been panned but clings to a single good review found plastered all around its walls and windows: you hope that single review will make your meal memorable, in a positive way. Why take the gamble, especially when the cost is very comparable? Glucosamine sulfate may be more effective than prescription drugs
The evidence behind glucosamine sulfate in some ways exceeds that for any drug used to treat OA: duration of effectiveness
. Two three-year studies have shown a sustained reduction in pain and associated symptoms in persons with OA of the knee but also a slowing of the progression of the actual disease process
. Both studies employed specific X-ray methods to directly demonstrate a reduction of the rate of the structural damage within an affected knee. Of equal importance is the finding that side effects between the placebo and GS users were very mild and did not differ between the groups, a testament to the long-term safety and tolerability of GS. Study shows a single daily dose is all that's needed
One of the distinctive findings of these two 36 month studies is how
the subjects took the GS. Many marketers of glucosamine products recommend taking three doses of 500 mg per day. However, the majority of the evidence revealing a therapeutic effect of GS has used a single dose of 1,500 mg. Setting aside the evidence to support this dosing regimen, a single daily dose also makes compliance a whole lot easier. A bottle of GS permanently situated next to the toothbrush or in the center of the dining table, linked to the knowledge that "Once daily is all that I need" will likely promote a greater frequency of use and defer the need to buy a Ginkgo
extract to help remember to take it three times daily.
Glucosamine sulfate is one of the most well-researched natural products for chronic osteoarthritis, with robust safety and effectiveness data that overshadows even many over-the-counter and prescription drugs. The selection of the sulfate form, coupled with once-daily use (1,500 mg) would appear to be the evidence-based manner to extract the benefits reported in medical research studies.