Glucosamine may be hurting more than your wallet.

At the recent North American Spine Society annual meeting, a paper was presented about the supplement Glucosamine. Glucosamine has been promoted as a treatment for Osteoarthritis. It is widely sold as a supplement in combination with chondroitin. It is also marketed and promoted as treatment for mechanical low back pain. Glucosamine, an amino sugar, is thought to promote the formation and repair of cartilage. Chondroitin, a carbohydrate, is a cartilage component that is thought to promote water retention and elasticity and to inhibit the enzymes that break down cartilage. Both compounds are manufactured by the body. Glucosamine supplements are derived from shellfish shells; chondroitin supplements are generally made from cow cartilage.

Laboratory studies suggest that glucosamine may stimulate production of cartilage-building proteins. Other research suggests that chondroitin may inhibit production of cartilage-destroying enzymes and fight inflammation too. Some human studies have found that either one may relieve arthritis pain and stiffness with fewer side effects than conventional arthritis drugs. Other studies have shown no benefit. As the research accumulated, expert review bodies have been cautious because, although positive reports outnumbered negative ones, the negative ones have been larger and better designed .NIH GAIT trial is a good example of a well structured study. http://www.ncbi.nlm.nih.gov/pubmed/20525840. In addition, whether glucosamine offers any advantages over established drugs such as acetaminophen, traditional NSAIDS, or selective Cox-2 inhibitors has not been established.

Many of my patients take glucosamine to relieve chronic joint and back pain. There have been no proven risks to taking Glucosamine outside of allergic responses. Overall this supplement has been perceived as relatively safe. Recently at the North American Spine Society meeting an animal study was presented. It indicated that there may be a previously unknown problem with glucosamine. This well structured study demonstrated worrisome damage to vertebral discs in an animal model.

In the Supplement Proceedings of the NASS 27th Annual Meeting/The Spine Journal – September 2012 (Vol. 12, Issue 9, Supplement, Page S75, DOI: 10.1016/j.spinee.2012.08.214). Primary investigator was Dr. Gwendolyn Sowa MD, PhD. Her study demonstrated a significant negative effect on disc matrix both by imaging and tissue histological analysis. The Data Raised surprising concerns about the safety of Glucosamine in treatment of lower back pain. I spoke to Dr. Sowa after the meeting and expressed surprise about the results. She admitted this result was surprising to her. The focus of the research was to explore the efficacy of Glucosamine in lower back pain. She was astonished by the seeming negative effect of the supplement in the study.

Unfortunately this study cannot be found on pub med just yet. I have included it as a PDF file, Oral Glucoasmine Study.

From a science standpoint there are several issues with this study. It is an animal model. It is a single study that has not been duplicated. Rabbit discs are close analogs to human discs, but they do not walk upright.

What can we learn from this study?

I am not yet ready, on the basis of one study, to tell my patients that Glucosamine causes damage to their spine.  I do express concern about this study’s findings if they ask me specifically about glucosamine. In general I tell my patients that Herbal Supplements are an unknown. They are not risk free. You cannot depend on warning labels. Their benefits are unknown, and the dangers are unknown. Frequently the theoretical benefit has been proven untrue.

My patients often presume safety using the “naturalistic fallacy”(Natural=Good). Arsenic is 100% natural but I wouldn’t take it. Supplement takers are generally heavily emotionally invested in this fallacy. It would be good for them to know that many supplements are manufactured chemically not “naturally” and there is no way for the consumer to tell. It is acceptable in the US, under FDA guidelines to synthetically produce vitamins that can legally have an “Organic” label. Worse in some cases the supplement’s risks are known and product left unlabeled, such as elemental mercury in Krill oil, or shellfish allergies and Glucosamine.

If you get a drug in the US you get a three page dissertation about the side effects from the pharmacy. If a patient or a provider find that drug X gave you side effect Y either of us can contact the FDA with this problem. The FDA compiles side effect statistics from providers and patients about drugs. Over time complaints affect the dosage, recommendations and  warnings about the drug. It occasionally exposes unknown problems. This system is not perfect, but at least there is a system. The only system in the supplementation business is “try it”.

Going forward more research will be able to answer specifically if Glucosamine is in fact a problem for your spine. If it is, it will be shining example of how these supplements need to have rigorous experimental standards and monitoring. More importantly it is a good reminder that taking untested unregulated supplements are risky at best.

In my opinion, taking glucosamine and other unregulated herbal supplements is accepting that the people who have the greatest financial gain in this industry are looking out for your best interest. That gives me good reason to be skeptical.

 

 

 

 

 

 

About Stephen Propatier

Stephen Propatier is a board certified acute care nurse practitioner specializing in spine and sports medicine. He is a member of the Society for Science Based Medicine.
This entry was posted in Alternative Medicine, Health, Nature, Pseudoscience. Bookmark the permalink.

6 Responses to Glucosamine may be hurting more than your wallet.

  1. Mud says:

    Whilst I am surprised that glucosamine is found to be deleterious to health in a study, I would make two comments on the supplement.

    1) it has never been shown to be helpful to the victim.
    2) it has been show to be helpful to the sales folk who would have you for out for the stuff.

    Lets face it, A supplement should have a caveat. After ten years of major BS and unsupported literature, the suppliers should send 120% refunds.

  2. Walter Clark says:

    ” . . . is accepting that the people who have the greatest financial gain in this industry are looking out for your best interest. That gives me good reason to be skeptical.”

    Why isn’t it true that doctors would do everything they can, this side of illegal, to make you sick. Certainly their best advice would be withheld so as to be in their financial best interest. The only food that is sold at the grocery store is that which makes the most profit. The unsaid alternative to greedy people selling things to the public is control of the supply of everything by experts who works for bureaucracies who work out the detail parts of laws which politicians invent. In that case ONLY businesses that focus on politics rather than research will be lobbying the powers of the state to have the rules written their way. It will be far worse.

    It may be that Glucosamine is totally bogus but like tobacco, which is worse than bogus, bit if you make it illegal and it is something people want, you can raise the punishment to capital and there will still be a black market for the s**t. If however you want bogus s**t to go away, like tobacco use is (7% a year since the late 60s), then let it die on its own through articles that hopefully are more technically negative than this one.

    • Noah Dillon says:

      Doctors will have jobs even if you take great care of yourself. Some people have conditions, sometimes there are accidents, viruses are out there in the world, sometimes people slip on ice or in the tub or whatever, aging has terrible effects on the body. But what doctor have you ever talked to that tried to encourage you to be sick? My doctor tells me not to eat too much, to get exercise and sleep, not to smoke, not to drink to excess, etc. They’re never encouraged me to take anything dangerous or to do anything that might benefit them financially. I mean, you’d have to be a psychopath (Munchausen’s or a few other forms of mental illness to be exact) to want to make people sick for your own fulfillment. There just aren’t that many people in the world. Most people who want to be doctors, just like you’d expect, are people who want to learn how to keep people from being unwell.

      The foods that grocery stores sell are profitable foods. The foods that are profitable are the ones people want to eat. If people made other choices then grocery stores would sell other stuff. And look, if you go to any health food store, you’ll find organic all-natural locally made candy bars and pop tarts and all kinds of other junk. Why? Because even health-conscious people usually like sugary, fatty, salty food. And it’s in the interest of businesses that want to remain open to give their customers what they want (with the customers often requesting a product by name).

  3. Jim says:

    It’s in the Doctors interest for you to return. If they can give you something to temporarily make you feel good, even if it has long term negative affects, they will. Out of ignorance. They will do it because the pharmaceutical protocol tells them to.

    • Noah Dillon says:

      They’re ignorant of their own economic interest? Have you talked to any doctors about this hypothesis? They might remind you that inadequate treatment could result in complaints and even lawsuits against them, which will be far more costly than just giving you good advice and sending you on your way. When was the last time a doctor gave you a kind of weak-tea treatment designed to keep you hobbled and dependent? I’ve literally never had a doctor do any such thing.

  4. Wise says:

    I had a negative reaction from the use of Glucosamine and Chondroitin Sulfate Supplements not reported in any study. After trying this supplement for a few weeks I developed an arthritis like pain in the tops of my hands- in the bones before the knuckles. It felt like ache one would get after hitting something with the back of the hand. I did not realize that the supplement would have the opposite effect on aches and pains and continued taking it until the end of the bottle. The pain went away when I stopped taking this supplement. When I purchased a new supply, the pain came back. After they third or fourth cycle of this pain and remission, it dawned on me that the Glucosamine and Chondroitin Sulfate Supplement was the cause of the pain. While taking the last bottle of the supplement, I tested this observation by stopping and starting the supplement, and noticed the pain return after three days on this supplement. Once confirmed, I never used Glucosamine and Chondroitin Sulfate Supplement again and have never experienced that type of pain again.

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