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Glucosamine & Chondrotin (AOR)

DISCUSSION: Glucosamine and Chondroitin sulphate are components of the cartilage in joint tissue, and are used to support joint structure by aiding in the formation of connective tissue and protecting against the deterioration of cartilage from chronic joint diseases, while relieving the symptoms of bone and joint pain.Chondroitin Sulfate/Glucosamine SulfateChemistryGlucosamine is two hexosamine sugars common in animal cells. The synthesis of glucosamine begins with the enzyme glucosamine sythetase facilitating the transfer of amide group from glutamine to fructose-6 phosphate. The enzyme simultaneously isomerizes this compound to form glucosamine-6-phosphate (G-6-P). This molecule is the precursor to all hexosamine and hexosamine derivatives including: N-acetyl glucosamine, N-acetyl galactosamine and N-acetyl neuraminic acid. Chondroitin sulphate (CS) is a heterogenous group of glycosaminoglycan that is further classified into chondroitin-4-sulphate (CS4) or chondroitin-6-sulphate (CS6). CS functions as a component of proteoglycans. The low molecular weight and its high solubility enable GS to be readily absorbed in the blood stream (over 90% of an oral dose). Evidence indicates absorption of GS to be via active transport. GS is rapidly incorporated into articular cartilage. CS on the other hand is absorbed poorly due to the wide range of chain lengths and molecular weights. Estimations range between 0.8% and 8.5% absorption of CS intact. It would seem unlikely that the physiological benefits of CS are due to the intact molecule rather than to the increased availability of monosaccharide building blocks (glucuronic acid and N-acetyl glucosamine) created by the hydrolysis of CS during digestion and absorption.Clinical Applications of Glucosamine and Chondroitin SulphateGlucosamine is a very well studied joint-support supplement.• A review of a number of clinical studies showed that over 90% of patients reported improvement of symptoms after taking 1 500mg GS daily for 50 days. Arthritis of the shoulder or elbow responded the best, while polyarticular arthritis of the hip had the poorer rate- 43% reported feeling better compared to 49% who reported no improvement. CS in various formulations produced similar effects. Co-administration of CS resulted in 72% reduction in the effective dose of NSAIDs required to relieve pain.• Another study comparing Voltaren (a prescriptive NSAID) with CS showed that Voltaren produced a prompt reduction in clinical symptoms; however the symptoms reappeared quickly after the discontinuation of treatment. Patients treated with CS had a slower response to treatment, although the favorable response remained up to three months after discontinuation of treatment.• Forty-two patients (aged 35-78) with symptomatic osteoarthritis of the knee received 800mg daily dose of CS or placebo for 1 year. After 3 months, joint pain was significantly reduced. The difference in pain reduction became even more marked after 12 months (63% vs 26%; p<0.01).An Effective CombinationStudies using the combination of chondroitin sulfate and glucosamine have demonstrated its effectiveness.• In patients with capsulitis, disk displacement, disk dislocation or painful osteoarthritis of the temporomandibular joint, 1500 mg of glucosamine and 1200 mg of CS for 12 weeks reduced pain and joint tenderness, as well as the daily amount of over-the-counter medications required.• In another study, glucosamine (1500mg/day) and CS (1200 mg/day) reduced pain in patients with knee osteoarthritis who had been suffering from moderate-to-severe knee pain.Glucosamine and chondroitin sulphate are two effective nutrients for joint support. Their combination provides natural relief for joint pain.Referencesi. Setnikar I, Giacchetti C, Zanolo G.(1986). "Pharmacokinetics of glutamine in the dog and in man". Arzneim Forsch; 36: 729-733.ii. Balci, A. et al., (1992). "Analysis of glycos-aminoglycans in human serum after administration of chondroitin sulfate." Rheumatol Int; 12:81-88.iii. Conte A, Volpi N, Palmieri L, Bahous I, Ronca G. (1995). "Biochemical and Pharmacokinetic aspects of oral treatment with chondroitin sulphate". Arzneim. Farschi 45: 918-925.Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808.Nguyen P, Mohamed SE, Gardiner D, Salinas T. A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study. Cranio. 2001 Apr;19(2):130-9.