Glucosamine
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| Glucosamine |
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Glucosamine is a natural compound that is found in healthy cartilage.
Glucosamine sulfate is a normal constituent of glycoaminoglycans in cartilage
matrix and synovial fluid.
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Available evidence from randomized controlled trials supports the use of
glucosamine sulfate in the treatment of osteoarthritis, particularly of the
knee. It is believed that the sulfate moiety provides clinical benefit in the
synovial fluid by strengthening cartilage and aiding glycosaminoglycan
synthesis. If this hypothesis is confirmed, it would mean that only the
glucosamine sulfate form is effective and non-sulfated glucosamine forms are
not effective. Glucosamine is commonly taken in combination with chondroitin,
a glycosaminoglycan derived from articular cartilage. Use of complementary
therapies, including glucosamine, is common in patients with osteoarthritis,
and may allow for reduced doses of non-steroidal anti-inflammatory agents.
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2-acetamido-2-deoxyglucose, acetylglucosamine, Arth-X Plus®, chitosamine,
ChitoSeal, Clo-Sur PAD, D-glucosamine, disease modifying drugs for
osteoarthritis (DMOAD), enhanced glucosamine sulfate, Flexi-Factors®,
glucosamine chlorohydrate, Glucosamine Complex®, glucosamine hydrochloride,
glucosamine hydroiodide, Glucosamine Mega®, glucosamine N-Acetyl, glucosamine
sulfate, glucosamine sulphate, Joint Factors®, N-acetyl D-glucosamine (NAG,
N-A-G), Nutri-Joint®, poly-N-acetyl glucosamine (pGlcNAc), Poly-NAG, Syvek
Patch, Ultra Maximum Strength Glucosamine Sulfate®.
These uses have been tested in humans or animals. Safety
and effectiveness have not always been proven. Some of these conditions are
potentially serious, and should be evaluated by a qualified healthcare provider.
| Uses based on scientific evidence |
Grade* |
| Knee osteoarthritis (mild-to-moderate)
Based on human research, there is good evidence to support the use of
glucosamine sulfate in the treatment of mild-to-moderate knee
osteoarthritis. Most studies have used glucosamine sulfate supplied by
one European manufacturer (Rotta Research Laboratorium), and it is not
known if glucosamine preparations made by other manufacturers are
equally effective.Although some studies of glucosamine have not found
benefits, these have either included patients with severe
osteoarthritis, or used products other than glucosamine sulfate .
The evidence for the effect of glycosaminoglycan polysulphate is
conflicting and merits further investigation. More well-designed
clinical trials are needed to confirm safety and effectiveness, and to
test different formulations of glucosamine.
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A |
| Osteoarthritis (general)
Several human studies and animal experiments report benefits of
glucosamine in treating osteoarthritis of various joints of the body,
although the evidence is less plentiful than that for knee
osteoarthritis. Some of these benefits include pain relief, possibly due
to an anti-inflammatory effect of glucosamine, and improved joint
function. Overall, these studies have not been well designed. Although
there is some promising research, more study is needed in this area
before a firm conclusion can be made.
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B |
| Chronic venous insufficiency
"Chronic venous insufficiency" is a syndrome that includes leg
swelling, varicose veins, pain, itching, skin changes, and skin ulcers.
The term is more commonly used in Europe than in the United States.
Currently, there is not enough reliable scientific evidence to recommend
glucosamine in the treatment of this condition.
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C |
| Inflammatory bowel disease (Crohn's disease,
ulcerative colitis)
Preliminary research reports improvements with N-acetyl glucosamine as
an added therapy in inflammatory bowel disease. Further scientific
evidence is necessary before a recommendation can be made.
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C |
| Leg pain
Preliminary human research reports benefits of injected glucosamine plus
chondroitin in the treatment of leg pain arising from advanced lumbar
degenerative disc disease. Further scientific evidence is necessary
before a recommendation can be made.
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C |
| Rheumatoid arthritis
Preliminary human research reports benefits of glucosamine in the
treatment of joint pain and swelling in rheumatoid arthritis. However,
this is early information, and additional research is needed before a
conclusion can be drawn. The treatment of rheumatoid arthritis can be
complicated, and a qualified healthcare provider should follow people
with this disease.
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C |
| Temporomandibular joint (TMJ) disorders
There is a lack of sufficient evidence to recommend for or against the
use of glucosamine (or the combination of glucosamine and chondroitin)
in the treatment of temporomandibular joint disorders.
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C |
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often
have not been thoroughly tested in humans, and safety and effectiveness have
not always been proven. Some of these conditions are potentially serious, and
should be evaluated by a qualified healthcare provider.
AIDS, athletic injuries, back pain, bleeding esophageal varices (blood vessels
in the esophagus), cancer, congestive heart failure, depression, diabetes,
fibromyalgia, joint pain, knee pain, kidney stones, migraine headache,
immunosuppression, osteoporosis, pain, patellofemoral pain syndrome (PFPS- pain
behind the knee cap), psoriasis, skin rejuvenation, spondylosis deformans
(growth of bony spurs on the spine), topical hypopigmenting agent (combination
product containing multiple ingredients), wound healing.
The below doses are based on scientific research,
publications, traditional use, or expert opinion. Many herbs and supplements
have not been thoroughly tested, and safety and effectiveness may not be proven.
Brands may be made differently, with variable ingredients, even within the same
brand. The below doses may not apply to all products. You should read product
labels, and discuss doses with a qualified healthcare provider before starting
therapy.
Adults (18 years and older)
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In most available studies, 500 milligrams of glucosamine sulfate has been
used, taken by mouth as tablets or capsules three times daily, for 30 to 90
days. Once daily dosing as 1.5 grams (1,500 milligrams) has also been used.
Limited research has used 1,500 milligrams daily as a crystalline powder for
oral solution, or 500 milligrams of glucosamine hydrochloride
three times daily. Dosing of 20 milligrams per kilogram of body weight daily
has also been recommended in some publications. One study used a dose of 2,000
milligrams per day for 12 weeks.
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Another kind of glucosamine that has been used is a topical form in
combination with chondroitin for a four-week period. Safety and effectiveness
of these formulations are not clearly proven.
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Glucosamine hydrochloride provides more glucosamine than
glucosamine sulfate , although this difference likely does
not matter when products are prepared to provide a total of 500 milligrams of
glucosamine per tablet.
Children (younger than 18 years)
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There is not enough scientific evidence to recommend the use of glucosamine in
children.
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Research in children has shown that there could be a relationship between the
ingestion of MSM (methylsulfonylmethane) and autism; whether it is beneficial
or harmful is unclear. MSM is often marketed with glucosamine as a dietary
supplement and at this time should be avoided in children.
The U.S. Food and Drug Administration does not strictly
regulate herbs and supplements. There is no guarantee of strength, purity or
safety of products, and effects may vary. You should always read product labels.
If you have a medical condition, or are taking other drugs, herbs, or
supplements, you should speak with a qualified healthcare provider before
starting a new therapy. Consult a healthcare provider immediately if you
experience side effects.
Allergies
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Since glucosamine can be made from the shells of shrimp, crab, and other
shellfish, people with shellfish allergy or iodine hypersensitivity may have
an allergic reaction to glucosamine products. A serious hypersensitivity
reaction including throat swelling has been reported with glucosamine sulfate.
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There are reported cases suggesting a link between glucosamine/chondroitin
products and asthma exacerbations.
Side Effects and Warnings
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In most human studies, glucosamine sulfate has been well tolerated for 30 to
90 days.
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Side effects may include upset stomach, drowsiness, insomnia, headache, skin
reactions, sun sensitivity, and nail toughening. There are rare reports of
abdominal pain, loss of appetite, vomiting, nausea, flatulence (gas),
constipation, heartburn, and diarrhea. Based on several human cases, temporary
increases in blood pressure and heart rate, as well as palpitations may occur
with glucosamine/chondroitin products. Based on animal research, glucosamine
theoretically may increase the risk for eye cataract formation.
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It remains unclear if glucosamine alters blood sugar levels. Several human
studies suggest no effects on blood sugar, while other research reports
effects on insulin. Preliminary studies show no effect on mean hemoglobin A1c
concentrations in patients with type 2 diabetes mellitus. Caution is advised
in patients with diabetes or hypoglycemia, and in those taking drugs, herbs,
or supplements that affect blood sugar. Serum glucose levels may need to be
monitored by a healthcare provider, and medication adjustments may be
necessary.
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In theory glucosamine may increase the risk of bleeding. Caution is advised in
patients with bleeding disorders or taking drugs that may increase the risk of
bleeding. Dosing adjustments may be necessary.
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In several human cases, abnormal increased amounts of protein were found in
the urine of patients receiving glucosamine/chondroitin products. The clinical
meaning of this is unclear. Glucosamine is removed from the body mainly in the
urine, and elimination of glucosamine from the body is delayed in people with
reduced kidney function. Increased blood levels of creatine phosphokinase may
occur with glucosamine/chondroitin, which may be due to impurities in some
products. This may alter certain laboratory tests measured by healthcare
providers.
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Preliminary data suggest that glucosamine may modulate the immune system,
although the clinical relevance of this is not clear.
Pregnancy & Breastfeeding
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Glucosamine is not recommended during pregnancy or breastfeeding due to lack
of scientific evidence.
Most herbs and supplements have not been thoroughly
tested for interactions with other herbs, supplements, drugs, or foods. The
interactions listed below are based on reports in scientific publications,
laboratory experiments, or traditional use. You should always read product
labels. If you have a medical condition, or are taking other drugs, herbs, or
supplements, you should speak with a qualified healthcare provider before
starting a new therapy.
Interactions with Drugs
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In theory, glucosamine may decrease the effectiveness of insulin or other
drugs used to control blood sugar levels. However, there is limited human
research to suggest that glucosamine may not have significant effects on blood
sugar. Nonetheless, caution is advised when using insulin or drugs for
diabetes by mouth. Patients with diabetes should be monitored closely by a
qualified healthcare provider, and medication adjustments may be necessary.
Based on limited evidence, the combination of glucosamine with diuretics
(water pills) such as furosemide (Lasix®) may cause an increased risk of
glucosamine side effects.
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In theory, glucosamine may increase the risk of bleeding when taken with drugs
that increase the risk of bleeding. Some examples include aspirin,
anticoagulants ("blood thinners") such as warfarin (Coumadin®) or
heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal
anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®,
Aleve®).
Interactions with Herbs and Dietary Supplements
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In theory, glucosamine may decrease the effectiveness of herbs or supplements
that lower blood sugar levels. Caution is advised when using herbs or
supplements that may alter blood sugar.
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Based on limited human study, side effects of glucosamine may be increased
when used at the same time as diuretics herbs or supplements.
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In theory, glucosamine may increase the risk of bleeding when taken with herbs
and supplements that are believed to increase the risk of bleeding
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There are preliminary reports that use of glucosamine with vitamin C,
bromelain, chondroitin sulfate, or manganese may lead to increased beneficial
glucosamine effects on osteoarthritis. Simultaneous use with fish oil may have
additive beneficial effects in the treatment of psoriasis, based on
preliminary research.