There is a lot to that question, and we’ll cover some details below if you care to read more, but the basic answer is: it probably can’t hurt, and it might help.
We have recently noticed a surge in advertisements for these two products, with claims to offer major benefit for stiff and painful joints. So, we felt it would be helpful to pass along our assessment of the value of these supplements and our opinion of what is sensible vs. what is nonsense.
First, what are we talking about?
Glucosamine and chondroitin sulfate are natural substances found in and around the cells of cartilage. Glucosamine is an amino sugar that the body produces and distributes in cartilage and other connective tissue, and chondroitin sulfate is a complex carbohydrate that helps cartilage retain water.1 In the United States, glucosamine and chondroitin sulfate are sold as dietary supplements, which are regulated as foods rather than drugs1. The interest in using these elements became popular as a result of the reports of successful use in the veterinary arena and in the 1997 book “The Arthritis Cure”2.
Most of the reports on the use of these supplements have come from non-scientific reports. Many sources advocate the inclusion of other substances with the daily dose of glucosamine and chondroitin, thus it makes it difficult to know if in fact any effect or benefit noted is a result of the glucosamine, the chodroitin, both, or from one or more combinations of the other ingredients in the product being marketed.
An ingredient that many preparations include is MSM (Methylsulfonylmethane). The reported advantage of this chemical, that is found in small quantities in many foods, is that it provides sulfur to the body in a very useable form. Sulfur is reported as being beneficial because it helps in forming connective tissue cross-linkages.3 Glucosamine and chondroitin are the building blocks of joint cartilage and, thus, are bound together by sulfur bonds.3 So, combining MSM and glucosamine and chondroitin would seem to be sensible.
There is one recent study that points to the potential benefit of MSM. The paper was published in 2006 and reported on the results of a study done in 2004 by Southwest College Research Institute, Southwest College of Naturopathic Medicine & Health Sciences, Tempe, AZ. It was published in Osteoarthritis and Cartilage and reported statistically significant reductions in pain and in difficulty performing activities of daily living compared to a placebo control group.4
The scientific basis for use of glucosamine and chondroitin has been primarily grounded on the results of the 2006 study by the National Institutes of Health, “Glucosamine/chondroitin Arthritis Intervention Trial” (GAIT).5 Proponents as well as skeptics are able to find elements of this study to support their position, but the bottom line seems to be that for some patients there was relief of symptoms though no improvement of the overall degenerative changes within the knee. Thus, it may not help but it doesn’t seem to harm. Interestingly, of the almost 1,600 patients in the study, the small group in the moderate-to-severe pain group (22%) had significantly reduced pain while the larger “mild” pain group (78%) found no significant relief. Because of the small size of the subgroup the findings had to be classified as preliminary and thus need to be confirmed through larger studies to prove statistical significance.
So, what do we recommend based upon our reading and experience?
First, if you are going to try this dietary supplement then you should get a form of it that is of high quality so as to assure purity, potency, quality, and consistency among batches. Second, make sure the quantity of glucosamine and chondroitin is at a level at least that of the strength in the GAIT study – 1,500 mg glucosamine and 1,200 mg chondroitin. It is possible that MSM can help and so it makes sense to have a formula that includes that. Sources suggest between 1,500 and 6,000 mg. per day. We think the lower end of that scale makes sense. Lastly, since absorption in the intestine is important, the use of a liquid formula may allow for more complete uptake of the ingredients since pills have binding agents that may affect their breakdown within the stomach.
By Rett W. Talbot, PT, MS, SCS, ATC, CSCS
1National Institutes of Health National Center for Comlementary and Alternative Medicine “Questions and Answers: NIH Glucosamine/chondroitin Athritis Intervention Trial Primary Study” http://nccam.nih.gov/research/results/gait/qa.htm
2 “Glucosamine: Everything You wanted to Know” http://www.jointhealing.com/pages/productpages/glucosamine.html
3 “How MSM Works to Improve Joint Health”, http://www.msmguide.com/
4 “MSM Research Papers”, http://www.msmguide.com/
5 “Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT)” http://nccam.nih.gov/research/results/gait/