Synergistic and additive effect of chondroitin sulfate and glucosamine in stimulating cartilage tissue in osteoarthritis

Glucosamine is a monosaccharide produced and included in the main substance of the cartilage tissue of joints and synovial (periarticular) fluid. This monomer is synthesized by cartilage cells - chondrocytes. Glucosamine is a “building material” for the further biosynthesis of chondroitin, a specific polysaccharide of the extracellular substance of articular cartilage, including intervertebral discs.

The emphasis on these organic compounds was based on the idea that when there is a lack of glucosamine, cartilage tissue is progressively destroyed. Accordingly, with the additional use of drugs of this series (group name “chondroprotectors” or anti-rheumatological drugs), restoration of the structure of the joints is expected, that is, the treatment of osteoarthritis. Therefore, many researchers recommend additional intake of these substances as a dietary supplement to food.

How glucosamine and chondroitin work

The biological effect of glucosamine and its derivative, chondroitin, is to actively participate in the synthesis and constant regeneration of hyaline cartilage tissue. The mechanism of action can be briefly described as follows:

• in our body, glucosamine, when interacting with amino sugars, is converted into glycosaminoglycans;
• glycosaminoglycan molecules further combine with proteins and are converted into proteoglycans and chondroitin;
• chondroitin further polymerizes to form chondroitin sulfate;
• chondroitin sulfate promotes the fixation of sulfur during the synthesis of chondroitinsulfuric acid, which leads to the deposition of calcium ions in bone tissue.

Articular cartilage is 75% water. An important part of the work of chondroitin sulfate is the retention of water in the structure of cartilage in the form of water cavities. It is the high moisture content that provides good shock absorption and increased joint strength.

Another function is to prevent resorption (breakdown) of bone tissue. This effect is achieved by inhibiting the activity of the enzymes elastase and hyaluronidase, which damage bone tissue, and the constant production of new glycosaminoglycans.

A derivative of chondroitin, chondroitin sulfate, is similar in composition to heparin, so a number of scientists have noted its potential effect on the regulation of thrombus formation in the human body.

Indications for the use of glucosamine with chondroitin

The first, important factor indicating the need to take glucosamine with chondroitin is high physical activity. This can be not only the physical activity of athletes at the stadium or in the gym during training. This also includes groups of people whose daily activities involve constant movement, such as couriers who spend a lot of time on bicycles or loaders who strain their backs.

The second, no less important factor is age. In older people, the rate of synovial fluid production is reduced, and tissue elasticity is not the same as it was in youth. Any, even minor, loads lead to serious problems with the joints, since tissue cells can no longer recover at the required rhythm. People aged 65+ should discuss taking any medications with their local doctor, because there may be restrictions with certain concomitant chronic diseases.

The third factor indicating the need to supplement with chondroitin with glucosamine is the presence of injuries. Any damage to bones and joint tissues will be quickly forgotten, and motor activity will be restored if you help the body by taking chondroprotectors.

Signs of glucosamine and chondroitin deficiency

The lack of glucosamine and chondroitin in the body is expressed in a decrease in the strength of bone and cartilage tissue, which leads to the “erasure” of the hyaline cartilage layer between the bone parts of the joint. Early in the process, a person may notice an unusual “crunching” sound in the joint when moving. With the development of the degenerative process, inflammation of the damaged osteochondral areas occurs. The outcome is disorganization and destruction of cartilage - osteoarthritis.

How to choose glucosamine and chondroitin

There are many metabolism correctors on the modern market that contain glucosamine and chondroitin. This diversity is explained by the ease of extraction of the substance glucosamine and its chemical stability for inclusion in medications.

These compounds are approved as drugs for the treatment of osteoarthritis in Europe and as dietary supplements in the USA. According to clinical studies, chondroitin sulfate is easily absorbed when administered orally in capsule form.

The Federal Service for Surveillance in the Sphere of Consumer Rights Protection of the Russian Federation has established a recommended glucosamine consumption rate of 700 mg/day.

Other clinical studies of glucosamine sulfate and chondroitin sulfate have shown a decrease in the need for pain medications when used simultaneously with chondroprotectors for osteoarthritis.

It is important that glucosamine is pharmacologically compatible with non-steroidal anti-inflammatory drugs and glucocorticosteroids, which are used in the long-term treatment of arthrosis.

We assessed the quantitative content of the glucosamine + chondroitin complex from different manufacturers and correlated it with the cost of the entire package. Thus, the most profitable purchase of this dietary supplement was determined - a complex of glucosamine and chondroitin plus MSM from the company. The ratio of the quantity of grams and the price of the drug is 0.157. The most expensive complex was proposed by Bluebonnet Nutrition and Thorne Research (quantity-to-price ratios of 0.028 and 0.031), which turns out to be almost 6 times more expensive.

Selection table

Glucosamine + chondroitin complexes from Bluebonnet Nutrition, Solgar and one of the 21st Century products are additionally enriched with MSM (methylsulfonylmethane). This is a sulfur-containing compound involved in the construction of muscle and cartilage tissue.

Features of choice

When choosing a drug, pay attention to the composition of the formula, the presence or absence of additional components, as well as the combination of “amount of substance / cost of packaging.” Another important aspect is adherence to the chosen regimen of taking the drug, so choose the frequency of taking the supplement per day that is convenient for you.

Glucosamine/chondroitin: complex or separately

Based on the fact that the use of each component is recommended under certain circumstances due to different indications, the question arises whether complex chondroprotective drugs can be used or whether it is necessary to make a choice in favor of only one of the substances. Experts say that regardless of what caused the discomfort, it is still better to use complex therapy, since the ability to complement each other’s benefits enhances the positive effect.

Advantages of an integrated approach:

• simultaneous comprehensive action;
• complex preparations allow you to satisfy the body’s daily need for glucosamine and chondroitin in one go;
• from the point of view of rational spending of the budget, the complexes are almost twice as profitable.

You should not separate the two substances, since they do not interfere with each other's action. By activating the production of synovial fluid, it will not be superfluous to strengthen the articular ligaments and increase the elasticity of the cartilage. An integrated approach will give better results. In addition, simultaneous use of drugs will help not only restore lost joint function, but also prevent incipient pathology. It is always easier to prevent a problem than to solve it. This is especially true for joints. When cartilage production begins, there is no pain yet. It will not be possible to identify the problem until the deformation of the cartilage makes itself felt. An integrated approach will eliminate the development of pathology before it manifests itself in a decrease in quality of life

Literature[edit | edit code]

1. Guide to joint support by Jim Wright, PHD
2. Monfort J, Pelletier JP, Garcia-Giralt N, Martel-Pelletier J. Biochemical basis of the effect of chondroitin sulfate on osteoarthritis articular tissues. Ann Rheum Dis 2007; doi:10.1136/ard.2006.068882 .
3. Bourgeois F, Chales C, Delais J, Delcambre B, Kuntz JL, Rozenber S. Efficacy and tolerance of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3×400 mg/day vs placebo. Osteoarth Cart 1998;6 Suppl A:25-30.
4. Jamie G. Barnhill, Carol L. Fye, David W. Williams, Domenic J. Reda, Crystal L. Harris, and Daniel O. Clegg. Chondroitin Product Selection for the Glucosamine/Chondroitin Arthritis Intervention Trial. J Am Pharm Assoc. 2006; 46:14–24.
5. Gichev Yu. Yu., Gichev Yu. P. Guide to micronutrientology. The role and significance of biologically active food additives. - M.: "Triad-X", 2006. - 264 p. — P. 151

Sports nutrition or drugs?[edit | edit code]

In the USA, this chondroitin sulfate is included in the list of dietary supplements, although in 22 other countries it is a medication. For this reason, America does not have any production standards. According to studies, it was found that only 10-15% of dietary supplements called “chondroitin” sold on the American market fully correspond to their name in composition.

In European countries, such a problem does not exist, since the production of chondroitin is controlled according to all pharmacological standards. For the same reason, medications with chondroitin have a higher level of quality.

If we compare the price-quality ratio, then preference should be given to sports supplements. So, if the concentration lags by 10-30%, the price of additives can be 2-3 times lower.

Best supplements[edit | edit code]

The highest quality indicators were obtained when testing the following supplements (it is better to purchase complex supplements that also include methylsulfonylmethane, glucosamine sulfate and other active ingredients):

• Bone Boost by SAN
• Animal Flex by Universal Nutrition
• Glucosamine + UNIT from ESM
• Glucosamine + CSA Super Strength from Optimum Nutrition
• Glucosamine + Chondroitin from Weider
• Glucosamine + Chondroitin + MSM from Ultimate Nutrition

Common Forms of Glucosamine

Depending on the origin, the substance is as follows:

• Glucosamine hydrochloride of animal origin. Made from the shell of crustacean mollusks. It is considered the most common and accessible, but can cause allergies. The following designations will tell you about the origin: Chitin source (source - chitin), Shellfish source (source - mollusks), Marine source (sea source), Shrimps, crabs (shrimps, crabs), etc.
• A similar form of plant origin. Made from corn husks. Does not contain allergenic animal protein. Today this form is considered optimal, but is more expensive than others. On the packaging you can see the following designations: Corn (corn), not from shellfish (not from crustaceans), 100% Vegetarian, Vegan, Vegetarian Source (vegetarian source), etc.
• Glucosamine sulfate stabilized with potassium chloride. Also of animal origin. Well tolerated due to high biological compatibility with the body.
• Glucosamine sulfate stabilized with sodium chloride (table salt). The peculiarity is that when taking such a drug, the body receives excess salt. 1500 mg of glucosamine includes 400 mg of salt - almost a daily dose. This form requires avoiding eating other salty foods.

Glucosamine hydrochlorides contain about 83-88% of the pure substance, and sulfates - no more than 59-65%. The remaining components in them are ballast components. Based on the level of safety, benefit, digestibility and effectiveness, these four forms are arranged in the following order:

1. Vegetable hydrochloride.
2. Animal hydrochloride.
3. Sulfate stabilized with potassium chloride.
4. Sulfate stabilized with sodium chloride.

You need to be careful with glucosamine sulfates: some contain too much salt

Side effects[edit | edit code]

Historically, humans naturally consumed chondroitin sulfate and other chondroprotectants through the consumption of foods such as tendons and cartilage from animals, birds, and fish. In the diet of modern humans, the proportion of chondroitin has been significantly reduced, so some scientists believe that its additional intake can only have a beneficial effect on human health.

During clinical trials, no side effects were identified, and no overdose of chondroitin was recorded. Recent studies have confirmed that it is one of the safest remedies for the treatment of osteoarthritis and other diseases of the joints and ligaments. This is due, among other things, to the absence of any drug interactions.

When should you buy chondroitin glucosamine and at what price?

A crunching sound when playing sports, painful sensations even in a state of calm, limited joint mobility - these are the first signs of disorders of the musculoskeletal system and a distress bell, signaling the need to replenish the balance of glucosamine in the body. Most often these symptoms occur due to:

• improper load distribution during intense training;

• sports injuries;

• using uncomfortable shoes (tight socks, high heels and even synthetic materials irritate and deform the foot);

• obesity (when walking, the spine is forced to withstand a weight four times the body weight of its owner, so even a couple of extra kilos are important for the spine);

• hormonal and age-related changes (especially for women during menopause).

As you can see, nutritional supplements based on chondroitin are needed not only by athletes, but also by women over 40, and people with metabolic disorders, and those suffering from fractures, osteoporosis, osteoarthrosis or osteochondrosis, and simply those who adhere to the Hippocratic principle: “It is easier to prevent how to cure” and uses chondroprotectors to prevent injuries and strengthen ligaments.

How much glucosamine do joints need?

You can avoid treatment for arthrosis or osteoarthritis if you maintain the required level of glucosamine in the body. The lower limit of normal is 700 mg. Experts from various European associations have concluded that a person should receive 1500 mg of glucosamine daily to prevent degenerative age-related changes in the joints. This is especially true after fifty years, when cartilage tissue ceases to cope with its functions.

The daily dose of glucosamine also depends on the person’s weight:

• with a weight of up to 55 kg, 1000 mg (and 800 mg of chondroitin sulfate) is sufficient;
• 55-90 kg – standard dosage (1500 mg glucosamine and 1200 mg chondroitin);
• over 90 kg - the dosage increases to 2000 and 1600 mg, respectively.

Glucosamine is found in corn and wheat