Glucosamine for Healthy Joints

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Are you at a stage in your life where your bones and joints are beginning to feel a bit stiff and sore? For a start, you could feel a mild stiffness in the morning followed by creaking, cracking joints. You could also find that sitting down or standing up seems to pose quite a bit of a challenge.

Well, at least you can take heart that you are not alone. It’s a fact that as we get older, our joints also age along with us. Increasing joint problems, especially those affected with loss of joint cartilage due to wear and tear and/or injury, is a key issue that affects any aging population.

Consider joint care and management earlier in life, especially from the peak age of 30, to ensure your joints do not let you down too soon as you get older.

Bones

Your bones make up the main skeletal framework of your body. Your skeletal framework not only allows you to stand and walk, but also protects your internal organs. Although bones are strong, they remain flexible because they are linked to each other at intersections called joints.

Joints

There are several kinds of joints:

• Hinge joints – most notably in the elbows and knees. Allow the body parts to bend and straighten.
• Ball and socket joints – the shoulder and hip. Allow twisting and turning.

The joint capsule is a tough membrane sac that holds all the bones and other joints together. Synovium is a thin membrane inside the joint capsule, while the synovial fluid lubricates the joint and keeps the cartilage smooth and healthy. Keeping the joints together and stable are the ligaments.

Pain, swelling and stiffness are likely to develop if the structure or functioning of a joint is disrupted. This could make it difficult to carry out everyday activities.

Cartilage

Covering the ends of the bones is a smooth, hard cartilage that acts as a shock absorber, and a joint protector. Tough, elastic and very durable, the cartilage allows the bones to ride smoothly and effortlessly over each other. Consisting of collagen and water molecules, the cartilage does not have a blood supply. The cartilage relies on its ability to absorb nutrients, oxygen and fluid in order to function without a blood supply.

When we move a joint, the pressure across the joint expresses fluid and waste products out of the cartilage cells. When the pressure is relieved, the fluid diffuses back, carrying a supply of oxygen and nutrients. In short, the health of the cartilage depends largely on the health of the joints.

A continued, progressive loss of cartilage can lead to serious discomfort and eventually, reduced mobility. Two key cell factors are crucial to the process of replacing the cartilage in the joint. Special cells called chondroclasts break down old cartilage and remove it from the site, while other cells, called chondrocytes, help to replace the cartilage tissue by using essential nutrients, which include glucosamine.

Understanding Joint Diseases

Arthritis

Arthritis refers to the inflammation of a joint or joints in the body. As a person’s age increases, so does the possibility of having arthritic conditions. Scientists and doctors in rheumatology have uncovered that there are over 100 different types of arthritis.

Osteoarthritis

The most common type of arthritis is osteoarthritis. Also known as degenerative joint disease, osteoarthritis is most prevalent in people aged 55 and older. It also affects more women than men. Osteoarthritis describes a condition where the cartilage cushion in the joint breaks down. This causes the bones to rub together, resulting in pain, stiffness and in some cases could lead to the formation of bone growths called spurs.

Osteoarthritis can affect any joint, but it is most common in the hands, feet, spine and large weight-bearing joints such as the hips and knees.

Although osteoarthritis is often attributed to general tear and wear associated with aging, it can also be caused by other problems like obesity, injury or repeated joint stress.

Rheumatoid Arthritis

Often regarded as the most serious, painful and disabling of all forms of arthritis, rheumatoid arthritis is prevalent in people between the ages of 20 and 40. Three times more likely to affect women than men, rheumatoid arthritis occurs most often in the same joints, on both sides of the body, for example, the hands, wrists, elbows, shoulders, knees, ankles and feet. Symptoms include swelling, pain, redness and warmth.

Rheumatoid arthritis occurs when the synovial membrane becomes swollen and inflamed, causing pain and stiffness. Chemicals released in the inflamed tissue increase blood flow to the joint. This causes the joint to appear red and feel warm to the touch. Patients with rheumatoid arthritis have the tendency to favour the affected joints by holding them in a fixed position to reduce pain. This, however, causes the muscles surrounding the joints to stiffen and weaken. Tendons, which attach muscles to bone or to other muscles, may also tighten. As a result, joints may contract or change shape, and patients may eventually lose mobility.

Gout

Unknown to many, gout is a form of arthritis. It is often characterised as an inflammatory form of arthritis that causes severe, and often, sudden attacks of pain in some of the joints. Usually, only one joint is affected at a time, but the symptoms can come and go. Unlike the inflammation in RA, joint inflammation in gout is caused by the deposits of sodium urate crystals from excess uric acid, a waste product circulating in the blood.

Overindulgence in alcohol consumption, excessive meat, refined carbohydrates and sugar consumption, and obesity as well as reduced renal clearance of uric acid may increase an individual’s risk of developing gout. Gout is one of the most treatable forms of arthritis. With proper treatment and care, inflammation can be prevented entirely.

Osteoarthritis

A condition that occurs most frequently among older people, osteoarthritis can strike across various age groups, sex and geographic areas. It is also known commonly as degenerative joint disease or “wear and tear arthritis” due to its association with aging and injury. It is characterised in x-ray findings by decreased joint space and bony spurs.

Over many years and with activity as well as use of a joint, the cartilage in the joint may become frayed, injured and torn. In some instances, it may even wear away entirely. This allows the bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint.

Over time, the joint may lose its normal shape. In addition, bone spurs (called osteophytes), may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain, damage and even swelling.

In advanced cases, walking or regular daily activities may become difficult or impossible. Synovial fluid may accumulate in the affected joint, giving it a swollen appearance. The synovial fluid generated from the soft tissue in the knee, tries to create more lubrication to make the joint surfaces smoother. A knee may feel unsteady, stiff, or have a sensation of giving out when weight is placed on it. Additionally, a feeling of knocking or grinding may be felt in the joint.

Unlike rheumatoid arthritis which also affects other parts of the body, osteoarthritis affects only joints and not internal organs. Compared to osteoarthritis, rheumatoid arthritis can begin at a younger age, causing swelling and redness of joints, and may make people feel sick and tired.

Osteoarthritis can be divided into:

• Primary osteoarthritis: commonly occurs with aging, as the water content in cartilage increases while the protein portion degenerates.
• Secondary osteoarthritis: is usually due to another disease or condition, repeated trauma, infectious disease, gout or surgery on a joint. Obesity is a contributor, as excess weight put additional stress on the cartilage, particularly the joints in the knees and hips.

What are the common areas affected by osteoarthritis?

Osteoarthritis most often occurs at the ends of the finger, thumb, neck, lower back, knee and hip.

What are the common causes for osteoarthritis?

Osteoarthritis can be caused by any or a combination of the following risk factors:

• Being overweight
• The aging process
• Joint injury or fractures around a joint surface
• Stress placed on the joint from certain jobs or sports activities
• Hereditary

What are the symptoms of osteoarthritis?

• Stiff and painful joints are the main symptoms. The pain tends to worsen on exercising the joint and at the end of the day. The joint may not move as freely or as far as normal, and often “creaks” or “cracks” when moved. Occasionally the joint seems to give way because of weak muscles or loss of stability.
• Symptoms often vary for no obvious reasons, with bad spells of few weeks or months being broken by much better periods. Changes in the weather (especially damp or rainy weather) can worsen joint pain for some people. Others may find it depends on how much physical activity they do.
• Often, the joint appears swollen, due to hard bony esteophytes or extra synovial fluid (which will feel soft) while the muscles around the joint look a little thinner.
• In some advanced cases, more severe and constant pain may develop and occur not only with or after exercise, but even at rest or at night. Certain daily tasks and activities may then prove difficult, depending on which joint is affected. Mobility may be affected due to pain on walking. These difficulties can restrict what you can do and limit your independence.

Note: Osteoarthritis is a medical condition and should not be self-diagnosed. To find out if you are at risk, please consult your physician for a medical check-up.

For most people with osteoarthritis, the best advice is:

• Rest between activities
• Decrease your speed
• Do housework or gardening in short spells interrupted by short rests
• Avoid sitting in one place for too long – get up and stretch the joints from time to time.
• Break up car journeys with frequent stops to walk around
• Avoid exercises that place excessive stress on the joints
• Engage in a balanced fitness programme that includes walking, swimming, biking – all aimed at shorter distances – and stretching exercises.
• Try to cut down on carrying heavy things/load.

 What mechanical aids can benefit a person with osteoarthritis?

• Wearing shock–absorbing soles in shoes or orthopaedic shoes can help in daily activities and during gentle exercise.
• Over the counter elastic supports can be used on affected knee and wrist joints, but it is important to check with a physician before using one.
• A firm mattress also often proves beneficial
• Canes, crutches, or walkers offer benefits to patients with advanced arthritis

Support Normal Joint Health with Glucosamine

Glucosamine is an amino monosaccharide derived from chitin in crustacean shells. Glucosamine is a naturally occurring substance found in cartilage that stores water. It keeps cartilage strong and flexible. As we age, natural production of glucosamine slows down, resulting in a deterioration of cartilage known as osteoarthritis. Glucosamine hydrochloride is a natural substance which stimulates the manufacture of substances necessary for cartilage repair and aids in restoring proper joint function. Thus, it helps to slow down the progression of osteoarthritis without some of the unpleasant side effects of conventional drug treatments.

The body requires the raw materials (glycosaminoglycans) which the joint cartilage requires for repairing joint cartilage tissue. The body requires these glycosaminoglycans (a polysaccharide)  to produce proteoglycans (mortar-like substances made from protein and sugar that are building blocks of cartilage that help absorb the shock of body movements and provide the joints with strength and elasticity) prior to the deposition of collagen in the joint. The availability of these glycosaminoglycans determines the rate of cartilage formation. Glucosamine provides the important glycosaminoglycans to the joints to help in cartilage formation.

Who can benefit from taking glucosamine?

Anyone who wants:

• a relieve from joint pains and to protect the cartilage
• to manage osteoarthritis
• to reduce inflammation
• an aid to  rebuild and rehabilitate damaged cartilage
• an aid in recovery from orthopaedic surgery

How does glucosamine help athletes?

For anyone involved in sports activities, injury is a way of life. It does not matter if you engage in these activities professionally or for recreation, you are at risk all the time

Sports injuries may not just mean broken bones or sprained ankles, but also more insidious kind of injuries that can leave you with debilitating pain for the rest of your life.

For active athletes, the slightest injury can result in the development of “secondary” osteoarthritis. Athletes can lose functional capability in one or more joints very quickly, and of course may be subject to a lifetime of debilitating pain.

To perform at peak level, your joints must be at top condition. Given the availability of glucosamine hydrochloride without prescription, a smart athlete will take a proactive role in taking a glucosamine formula as a preventative measure and as an adjunct to improve joint health.

Is there any research update to substantiate the use of glucosamine in the treatment of osteoarthritis?

Positive Findings

A systematic review by the Cochrane Database found that there was evidence that glucosamine is both safe and effective in osteoarthritis.² Glucosamine was found to be statistically superior to placebo in 12 of 13 trials in which such a comparison was made. In addition, in four trials comparing glucosamine to a non-steroidal anti-inflammatory drug (unspecified), glucosamine was superior in two, and equivalent in two.

Safety

There is published research demonstrating that glucosamine at high intravenous doses in animals can interfere with insulin signalling. Some investigators have extrapolated these findings to suggest that glucosamine might increase risk of diabetes.¹⁴ However, development or worsening of diabetes has not been reported in clinical trials of oral glucosamine taken for up to three years, and 13 placebo-controlled, double-blind trials, each of at least 4 weeks in duration, attest to the safety of glucosamine, which was associated with no more adverse effects than placebo.² Considered in this context, although there is no cause for concern, it is advisable for individuals on medication to consult with their physicians prior to taking glucosamine. 

Overall Conclusions

• Research conducted on glucosamine since 1997 strengthens the evidence in favour of its efficacy for reducing inflammation and pain associated with osteoarthritis.
• The effective glucosamine dose reported in the literature is 1500 mg per day.
• Individuals taking medication should consult their physicians prior to taking glucosamine.

References:

² Towheed, T. E., Anastassiades, T. P., Shea, B., Houpt, J., Welch, V., and Hochberg, M. C. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2001;1:CD002946. 

¹⁴ Nakamura, M., Barber, A. J., Antonetti, D. A., LaNoue, K. F., Robinson, K. A., Buse, M. G., and Gardner, T. W. Excessive hexosamines block the neuroprotective effect of insulin and induce apoptosis in retinal neurons. J Biol Chem 2001 Nov 23;276(47):43748-55. 

Glucosamine is derived from shellfish? What is the exact source of the glucosamine?

Glucosamine is derived from shrimp

What potential beneficial effects do active ingredients have in the body?

Glucosamine offers a way to supplement the diet with compounds that may help improve range of motion and flexibility and improve joint and cartilage health.

Glucosamine is a precursor for glycosaminoglycans, which are the major component of joint cartilage that serves as a "cushion" between the bones of the joints. Glucosamine is the main building block for semi-fluids that lubricate joints.

Are there any other physical states/conditions for which use of this product is contraindicated?

There is no evidence of any contraindications with use of this product.  However, as with any supplement, those under medical care should consult with their personal physician before using this product. Anyone with a medical condition, including diabetes and hypoglycemia, should consult with a physician before using this product.

Are there any potential side effects from taking this product?

There is no evidence of any potential side effects from taking this product.  However, as with any supplement, anyone should consult with his/her personal physician before using this product.

What would be the consequences of consuming over 2000mg of glucosamine per day?

Glucosamine appears to be safe and well tolerated. However, consuming over 2000mg of glucosamine per day is not recommended. Extremely high levels of glucosamine can cause gastric fluctuations such as soft stools, diarrhoea or nausea. Recommended dosage is 1500mg.

When should this product be taken?  With meals?  Empty stomach?   Can it be taken with other dietary supplements?  How many capsules/tablets are recommended to be taken at one time?

This product should be consumed as two capsules twice daily, preferably first thing upon waking in the morning and again in the afternoon or early evening. The directions call for Glucosamine to be taken  wice a day because of its pharmacokinetics. If it were taken only once a day, for a good part of each day there would be very low concentrations of glucosamine in the body, undermining the cumulative health benefits.  Thus the usual recommended dosing schedule for all glucosamine products is two or three times a day. 

The direction to take it first thing in the morning stems from the pattern of joint stiffness and pain peaking in the morning: it makes sense therefore to take it as early as possible. 

The second dose would ideally be 8-12 hours later. At this time there is no information available to discourage use of this product with other dietary supplements.

What environmental conditions may decrease the active ingredients potency?

Environmental conditions such as heat, exposure to air, open cap allowing oxidation to occur can decrease the nutrient activity and potency stated on the label.

    Research citations used to support this document.

Ingredient	Research Citations
Glucosamine	Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V, Hochberg MC, Wells G.  Glucosamine therapy for treating osteoarthritis.  [Update of: Cochrane Database Syst Rev. 2001;(1):CD002946.]  Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002946.
Glucosamine	Reginster JY, Bruyere O, Fraikin G, Henrotin Y.  Current concepts in the therapeutic management of osteoarthritis with glucosamine.  Bull Hosp Jt Dis. 2005;63(1-2):31-6.
Glucosamine	Anderson JW, Nicolosi RJ, Borzelleca JF.  Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy.  Food Chem Toxicol. 2005 Feb;43(2):187-201.
Glucosamine	Dodge GR, Jimenez SA.  Glucosamine sulfate modulates the levels of aggrecan and matrix metalloproteinase-3 synthesized by cultured human osteoarthritis articular chondrocytes.  Osteoarthritis Cartilage. 2003 Jun;11(6):424-32.

Keeping the joints healthy

Being proactive goes a long way in overall bone and joint health. This also enables us to reduce the risks of joint diseases like arthritis, and slow down wear and tear or degeneration of the joints.

It can range anywhere from a  degeneration or “wear and tear” of joint surface cartilage, accompanied by an overgrowth of bone (osteophytes), narrowing of the joint space or hardening of the bone at the joint surface and deformity of joints – broadly under the category of “arthritis”. Whether someone already has arthritis or not, it is important to try and keep the joints in good working order with regular exercise and a healthy diet.

Why exercise?

Exercise keeps the supporting muscles and ligaments strong and relieves pain. Furthermore, combined with a healthy diet, exercise helps keep weight under control, thus lessening the impact and load placed on the legs and the joints by the upper part of the body. Losing weight also helps relieve damaging pressure on the joints. And, contrary to popular belief, regular exercise, for example swimming, is beneficial for osteoarthritis since it improves the function of the joints and helps reduce pain. So the negative cycle of joint pain, inactivity, weight gain and worsening joint pain can be reversed to become:

More Activity ð Weight Loss ð Less Joint Pain

Because cartilage has no blood supply of its own, exercising the joint is important to ensure it receives adequate levels of nutrients. As the joint is moved, it compresses the spongy cartilage material, expelling the fluid it contains and allowing new, richer nutrient-containing fluid to enter. This is the reason that mild to moderate exercise is important to help maintain joint health and mobility.

Will exercises help?

Exercise is one of the best treatments for osteoarthritis. Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight, and promote general physical fitness.

Exercise is also inexpensive, and , if done correctly, has few negative side effects. The amount and form of exercise will depend on which joints are involved, how stable the joints are, and whether a joint replacement has been done.So if you want to move better, move often.

A healthy diet

A healthy diet emphasising fruit, vegetables, and whole grains can help you control your weight and maintain your overall health, allowing you to have better bone and joint health in the long run

Important nutrients to note would be:

Nutrient	Function	Sources
Calcium	Keeps the bones strong	Skim or low fat dairy products, fish with edible bones like sardine, nuts, seeds, whole grains and cereals.
Essential fatty acids like omega 3	Believed to reduce the process of inflammation and subsequent joint damage	Fish like Salmon omega, Tuna, Mackeral, Cod Fish, Flax seed, pumpkin seeds and walnuts
Antioxidant vitamins like A,C and E	Beneficial through their antioxidant function. May help tissue damage from inflammation	Yellow, orange and green coloured fruits and vegetables, nuts, cereals and whole grains. Vegetable oils, and low fat dairy products
Vitamin D and Magnesium	Plays a pivotal role in nutrition by  facilitating absorption of calcium , thereby helping to support strong and healthy bones and joints. Also important in promoting bone mineralization in conjunction with other vitamins , minerals and hormones	Vitamin D : Fortified low fat fat or skim milk, fortified cereals, butter, margarine, liver and egg yolk. Magnesium: Green, leafy vegetables, legumes, whole grain cereals, seafood, nuts and seeds.
Protein	Essential to form collagen which is fibrous protein found in bones, ligaments, cartilage, tendons and connective tissue	Protein rich foods include low fat dairy products, sea food, poultry, and eggs.
B vitamins	For overall nerve health and for healthy blood circulation	Whole grains, cereals, fortified breads, legumes, fruits and green leafy vegetables, lean meats, poultry, low fat dairy products, liver, seeds and nuts

What other ingredients can also be combined to have a synergistic effect with glucosamine?

Ingredients that can work synergistically with glucosamine to help rebuild cartilage, ease pain, reduce inflammation and increase mobility include vitamins C, A and E, omega 3 fatty acids, B vitamins , protein and minerals like calcium, magnesium and vitamin D.

Additionally, bioflavonoids (from acerola cherry, lemons, limes, oranges and grapefruits) that have been referred to as vitamin P are good sources of antioxidants that can neutralise free radicals damage. They also help to strengthen the capillaries that are so essential for healthy blood circulation

Note: If one does not have an adequate dietary intake of the above nutrients, then it is advisable to consider supplementation to complement one’s diet.

Control your weight

Excess weight puts stress on your joints, in your back, hips, knees and feet – the places where joint pain is commonly felt. Excess weight can also make joint surgery more difficult and risky.

Apply heat

Heat will help ease your pain, relax tense, painful muscles and increase regional flow of blood. One of the easiest ways is to take a hot shower or bath for 15 minutes. Other options include using a hot pack, an electric heat pad set on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb to warm specific muscles and joints. If your skin has poor sensation or you have poor circulation, don’t use heat treatment.

Practice relaxation techniques

Muscle relaxation and deep breathing techniques can all be used to help ease joint pain or relax tenses muscles and joints.

Coffee

Coffee consumption of more than two cups a day may contribute to accelerated bone loss.

Medications

Certain medications, such as steroids and anticonvulsants contribute to bone demineralization.