A Joint Effort

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Every joint of your body is lined with cartilage. This cartilage helps your joint to function and helps the bones glide on each other. Normally, joints do not hurt or make noise, but if the cartilage breaks down and there are irregularities on the surface, joints can be a source of symptoms. If more cartilage is lost, joints can develop extra bone, lose motion and be a source of pain and possibly swelling. This is called degenerative joint disease (DJD) or osteoarthritis. Cartilage can be damaged from joint sprains or simply from postural forces.

Keeping cartilage healthy
Our cartilage has very poor blood supply and must get most of its nutrients from the joint fluid. You have certain nutrients in your cartilage that are necessary for maintaining the health of your joints. Some of these nutrients can be supplemented to enhance joint health for the purpose of maintaining the cartilage cells and the thickness of the cartilage layer. Glucosamine sulfate and chondroitin sulfate are nutrients that can be taken orally to support joint health.

Glucosamine sulfate
Glucosamine sulfate is a relatively small molecule that your body can readily absorb when taken orally. It is made from shellfish, so if you are allergic to shellfish you should avoid this supplement. I have been using glucosamine in my practice for 10 years and have found it helpful to heal sports injuries involving any joint and for arthritis of any joint in the body. It can also be helpful in pain relief after it has been taken for six weeks. Taking an anti-inflammatory drug such as ibuprofen or Naprosyn on a regular basis may adversely affect your cartilage. Taking glucosamine may help counter the adverse effects of the anti-inflammatory on cartilage.

The minimum dose of glucosamine has been found to be 1500 mg per day. It is probably a good idea to take slightly more than the minimum dose as the glucosamine distributes to all of the joints in your body, not just to an aching joint with DJD. You must take this supplement for a minimum of six weeks before there is any effect. You can think of this supplement as gradually helping to nourish cartilage cells and slowly helping to build the cartilage thickness.

How long you would take glucosamine depends on what you are using it for. If you are using it to support joints after an injury, use it for 10 to 12 weeks. If you are using it because you have arthritis you may want to continue it for at least four to six months to see if you have any benefit from it.

What forms are best?
Glucosamine is sold in many formulations. It may be sold as glucosamine complex, in which case it is a combination of three different types of glucosamine. It is also sold as pure glucosamine sulfate or as a combination formula with chondroitin. The most research has been done on the pure glucosamine sulfate, so I recommend that glucosamine be taken in the sulfate form. There are usually no side effects and it is safe for diabetics because there is very little glucose in it compared to the food that you eat. Some compounding pharmacies will compound glucosamine into a gel that can be rubbed on a joint, which can lead to higher amounts being absorbed into the joint. This can be helpful for thumb, ankle or knee joint arthritis.

Chondroitin sulfate
Chondroitin sulfate is a much larger molecule than glucosamine and is not digested and absorbed as easily. The source of most chondroitin is bovine trachea, which is the wind pipe of the cow. Recently, a few companies have created chondroitin with a low molecular weight from the shells of shellfish. This chondroitin has been shown to be more easily digested and, therefore, will likely be more beneficial than bovine source chondroitin. Numerous studies have shown chondroitin to be helpful in relieving arthritis symptoms. The minimum dose is 1200 mg per day, and it should be taken two to three times per day.

Chondroitin is also being researched as a fat blocker as it may be able to absorb fat from the digestive system. Because of this, you should take chondroitin away from fat-soluble vitamins, such as those found in multivitamins or in separate vitamins E and A.

Is one more beneficial than the other?
In studies it seems that glucosamine has been slightly more effective than chondroitin. If you are going to use joint support supplements, the first priority should be to take at least 1500 mg per day of glucosamine sulfate. If you are not getting enough relief after taking it for 8 to 10 weeks, you may want to increase the dose of glucosamine to 2000 mg. You can also add a low molecular weight chondroitin at 1200 mg per day or find a product that combines the two.

Many people are trying a supplement called MSM for joint support. There has not been sufficient research on this supplement as there has been on glucosamine and chondroitin. MSM is mostly sulfur, which is an important mineral for joints. It seems to benefit from MSM most people need to take more than four grams of it per day. It is important to ensure the MSM is from a reputable company as MSM may have some impurities in it and quality control is very important.

What about the combination joint support formulas?
Many people are taking joint support supplements but are not taking enough of them to make sure that they get at least 1500 mg of glucosamine per day. There can be quality and formulation issues with many of the joint support formulas, so it is a good idea to ask a nutritionist, a naturopath, a knowledgeable pharmacist, a chiropractor or a medical doctor about their preference for joint support formulas. Ask what they think of the one you are taking if you have already started on one.

When should you consider supplements?
Supplements can be useful after an injury such as an ankle, knee, hip back, neck or wrist sprain. Using them after an injury can reduce your risk of serious joint injury or arthritis in the future. They are especially important after a motor vehicle accident. You can use these if you already have osteoarthritis (DJD) in any of your joints. If you are using supplements for arthritis use them for at least four months at a time, if not indefinitely. Deciding which product to buy can be somewhat confusing, but using the guidelines above can help guide you and help you to protect your joint health. Remember, other forms of treatment including dietary changes and physical therapy may be helpful for joint health along with your supplements.

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