Glucosamine and Condroitin Sulphate

Question 1

Glucosamine

Answer 1

Glucosamine is an aminosugar naturally present in most body tissues, with high concentrations in joints and cartilage.
* Glucosamine is required for the synthesis of glycoproteins, glycolipids, and glycosaminoglycans (GAGs), also known as mucopolysaccharides.
* These compounds are an important
structural component of tendons,
ligaments, cartilage, synovial fluid,
mucous membranes and structures in the eye, blood vessels and heart
valves.

Question 2

Glucosamine Forms

Answer 2

Glucosamine can be supplemented in two different forms. All supplemental forms are highly bioavailable.
* Glucosamine 6 Phosphate (G6P) and N-Acetyl Glucosamine (NAG) are naturally present within the human body.
- NAG is converted to hyaluronic acid (HLA) as needed. HLA is an important component of synovial fluid.
* Glucosamine sulphate is sourced from marine exoskeletons (so not suitable for vegetarians, vegans and those with seafood allergies). It appears to be absorbed better and
hence result in higher tissue concentrations. Sulphate is
found in synovial fluid and is required for GAG synthesis.
* Glucosamine hydrochloride is created synthetically from corn.

Question 3

Glucosamine: Therarpeutic Uses

Answer 3

Osteoarthritis
IDB and intestinal permeability

Question 4

Glucosamine: Osteoarthritis

Answer 4

• Stimulates metabolism of
  chondrocytes in the articular cartilage and synovial cells in the synovial tissue. This slows joint degeneration
  and prevents joint space narrowing.
• Decreases inflammation by inhibiting the formation of cytokines such as interleukin 1.
• Pain reduction is comparable to NSAIDS. NSAIDS provide relief after two weeks compared to four to eight weeks for glucosamine sulphate.
• Less effective for severe, long
  standing osteoarthritis.
• More effective combined with chondroitin and MSM.
• Dosage: 1500 mg daily or in three divided doses.

Question 5

Glucosamine: IBD and intestinal permeability

Answer 5

• NAG supports the GI epithelial barrier by enhancing mucin functionality, which is dramatically altered in those with IBD. Mucins are a group of proteins found in mucus
  that form a barrier and prevent microbial overgrowth.
• NAG also reduces biofilm formation associated with IBD.
• NAG can be also used in intestinal permeability
• Dosage: 3 6 g daily for children; 6 g daily for adults in three divided doses. Administered orally or rectally.

Question 6

Glucosamine: Caution

Answer 6

Glucosamine supplements can be
synthesised in the laboratory, however most are produced from the shells of crustaceans so can be problematic for those with a seafood allergy.

Question 7

Glucosamine: Mild adverse effects

Answer 7

GIT symptoms such as nausea, heartburn, diarrhoea, constipation as well as drowsiness, skin reactions and headaches.

Question 8

Glucosamine: Interactions

Answer 8

Potential increase in the anticoagulant effect of warfarin, leading to increased risk of bleeding and bruising.

Question 9

Chondroitin Sulphate

Answer 9

Chondroitin sulphate is a type of glycosaminoglycan (GAG).
* It is a major component of the
extracellular matrix of many connective tissues. Most notably, this includes cartilage and joint connective tissue
* Chondroitin provides resistance to compression, partially by
thickening synovial fluid.

Question 10

Chondroitin Sulphate: Osteoarthritis

Answer 10

• Protects cartilage from degradation by:
• Reducing degradative enzymes.
• Decreasing inflammation reduces inflammatory intermediates such as COX-2. This is also seen by reductions in the inflammatory marker ‘CRP’.
• Increasing hyaluronic acid synthesis enhancing joint lubrication.
• Dosage: 200-400 mg two to three
  times a day or 1000 1200 mg daily as a single dose.

Question 11

Chondroitin Sulphate: Supplementation

Answer 11

Supplemental chondroitin is usually well tolerated. Studies show that people absorb only 8-18% of
orally administered chondroitin.

Question 12

Chondroitin Sulphate: Safety

Answer 12

There is some concern that chondroitin might exacerbate asthma. Patients with asthma tend to have higher concentrations of chondroitin
antibodies in the airway compared to people without asthma.

Question 13

Chondroitin Sulphate: Interactions

Answer 13

Potential increase in the anticoagulant effect of warfarin, leading to increased risk of bleeding and bruising.